Virtual Training Guide for Enhanced Care Management
Comprehensive guide and training tailored for ECM professionals.
Table of Contents
Welcome to Pear Suite’s Virtual Onboarding Guide for Enhanced Care Management (ECM)!
This training has been designed to help your organization successfully deliver and document CalAIM ECM services using the Pear Suite platform. Whether your team is new to ECM or just getting started with Pear Suite, this series will guide you through the core workflows, documentation practices, and review processes your team will need to understand before getting started. The video portion of the course will take about 45 minutes, and it's advisable to set aside an additional 30 minutes to practice and review the remaining workflows.
The training is broken into 3 self-paced modules, each covering a specific part of the ECM workflow. The full team should complete parts 1 and 2 as well as the practice. Only the Admin team responsible for claims management and reporting needs to watch part 3.
It’s important that every team member involved in service delivery, documentation, review, or oversight completes this training so your organization stays aligned on how to use Pear Suite correctly, document work accurately, and follow the required process. Throughout this training, your team will learn how to navigate the ECM workflow in Pear Suite, including how to create member profiles, complete intake steps, submit review requests, document services, support follow-up, and respond to internal review and correction processes.
1. Member Management: Adding Members, Importing Data, Member Dispatch
In this module, you will learn how to add a member manually or via import. You will be able to identify the key fields that are required for member creation, and which additional fields will enable billing and detailed reporting. You will practice updating their key demographic data so you feel comfortable navigating the key details in the platform. Finally, you'll learn how to assign members to a care pathway and LCM via member dispatch, preparing the member to be seen within your ECM program.
Adding a Member Manually: Required Fields for Creation and Billing
Importing Members in Bulk: Member Import File (MIF) Templates
Assigning ECM Core Details with Member Dispatch: Care Pathways and LCMs
In the next module, we will walk through how to complete an end-to-end workflow and what is needed along the way to fuel your ECM program reporting and drive healthy compliance.
2. Workflow Training: Navigating Enhanced Care Management and Completing Requirements
In this module, you will learn how to navigate an end-to-end ECM workflow, including the key steps, required actions, and what to look out for as you move through the process in the platform.
Understanding Key ECM Care Navigation Functionality: Care Pathways, Activities, and Care Plans
Using the Dashboard: Your Daily Schedule
Checking Medi-Cal Coverage: Availity Query Directly in Pear Suite
Completing ECM Outreach: Explanation of Outreach Objectives, Recording Key Outreach and Return Transmission Documentation
Generating an Outreach Claim: Timestamps, Billing Selections, and AI Generated Note
Member Profile Updates: Next Activities are Available to Start, ECM Status Group and Care Pathway Update
Comprehensive Assessment Navigation: Exit = Pause, Finish = Close and Lock Documentation, Billing PMPM
Follow Up Activity Overview: Return Transmission File Tracking, Care Navigation, and Updating Monthly Required Fields
In the next module, you will complete homework and practice activities to help reinforce what you have learned and build confidence using the platform.
Homework and Practice
In this section, you will complete practice activities designed to help you apply what you learned in the previous modules and feel more confident using the platform on your own.
- First, you will manually create a fake member in your system named [Your First Name] TEST with all the required fields for profile creation and billing filled out.
- Then you will apply an ECM care pathway.
- After that you will navigate through the core workflows (Outreach, Follow Up) using imagined member scenarios, including creating customized goals, referrals, and updating the care plan.
- Review and explore the Eligibility Screening, Comprehensive Assessment, and the Closure activity for graduating members.
Notify your Customer Success Manager when your team has completed their practice so we can tidy up your test members and prevent them from clogging up your system.
3. Admin: Reporting and Claims
\ECM Administration includes overseeing reporting of key details back to the health plans you contract with, as well as monitoring the submission of claims. This module will teach you how to use Pear Suite's prebuilt templates to pull your reporting, and make the modifications necessary for submission. It will also demonstrate how to review and submit claims for processing so that your organization can be properly reimbursed.
Monthly Reporting: Exporting Outreach Tracker Files (OTFs) and Return Transmission Files (RTFs)
Claims Management: Understanding the Claims Page, Resolving Various Errors, Reviewing and Submitting Claims
CONGRATULATIONS!! You’ve now completed the full ECM Self-Onboarding Training!
By practicing these workflows and using the tools within Pear Suite, your team is better prepared to deliver high-quality ECM services while keeping documentation clear, organized, and consistent.
Resources
📧 Support Questions
For platform or technical support: support@pearsuite.com
📧 Billing & Claims Questions
For questions about Medi-Cal billing, claims, or reimbursements: billing@pearsuite.com
📧 Sales & Partnerships
For new services, expansion, or partnership inquiries: sales@pearsuite.com
👤 Customer Success Manager
Your dedicated CS Manager is your go-to resource for workflow or onboarding questions.
With these resources at your fingertips, you’re fully equipped to succeed. Welcome to the Pear Suite network—we’re excited to partner with you and see the impact you’ll create in your community.