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CalLINKS WorkCare coordination: one member, one team, one recordTalk with us

For health plans

Referrals that arrive complete. Work you can see. Your system stays the record.

CalLINKS Work runs the community side of Enhanced Care Management and Community Supports. It prepares, checks and tracks. The plan decides.

Today it follows the review process of Central California Alliance for Health, the plan CalLINKS works with. Every referral shows where it stands: approved and awaiting submission, in Jiva awaiting decision, or returned for clarification. Nothing here replaces the plan’s system or decides eligibility, policy or payment.

Referrals and packets The Partner Workspace

Referrals

Checked before they reach Jiva.

Screening & Assessment is a screening aid, not an eligibility determination, and it says so at the top of every screen. Its job is to make sure what reaches your reviewers is complete and explained.

Before submission

The packet names its own gaps.

  • Pre-submit checks list exactly what is missing: Medi-Cal CIN, date of birth, housing situation, and anything else the assessment will ask.
  • The Jiva answer sheet uses the assessment’s questions word for word. Drafts the worker must personalize are flagged.
  • Borderline cases need a written justification, because the plan reviews those individually.
  • Each Population of Focus pathway shows what has been recorded and what is still needed to confirm it.

The right level of care

Not every referral should be ECM. The screening says so.

When ECM isn’t the fit, the screening shows the levels of care that are, such as the plan’s own case management, a Community Health Worker, or doula and birth equity supports, with plain words for the member about each.

The options that don’t fit are shown too, with the reason, so the case manager can explain them instead of sending a referral that will come back.

Care plans and housing

Built for your review, and clear about who decides.

Care plans

The plan shows what a reviewer looks for.

  • Each section explains what the plan is expected to show, including member voice, preferences and cultural and linguistic needs in the member’s own words.
  • It lists what is still owed: the member’s signature, and the Lead Care Manager attestation the plan expects.
  • Consent standing is read from the consent register, not typed in.
  • Updates are append-only. A correction is a new entry, so what was written on a date stays written on that date.

Housing

Packets recorded. Decisions yours.

Each housing case shows where it stands and the next step, and says plainly that sending the packet and the plan’s decision happen outside CalLINKS Work.

Deposit itemization runs against the $7,500 cap and Transitional Rent stays are counted, without blocking the work. Where the product can’t verify a rule, such as one request per household, it says so on screen.

Billing integrity

Checked before submission, not after a denial.

The Billing Integrity Validator checks a billing month against its own sources before anything is sent. It is not a billing engine. It creates no claim, and a named person submits.

A synthetic month: 60 candidate member-months, 35 accepted with evidence, and five blocking items named in plain language.
Exceptions with what clears them. A missing SDOH code is a cure inside the cycle, not an exclusion.

Evidence, not assumptions

Records are matched with where they came from, and the approved rules are applied the same way every month.

People make the calls

A blank Medicare flag isn’t read as yes or no. It waits for a person to confirm.

Submission stays human

BIV never transmits on its own. A named person submits through the existing process.

Partner Workspace

The partnership, in one shared place.

One place for the relationship itself, for CalLINKS and the plan together. It holds no member information, by design.

Campaigns

The work underway and the work proposed, in one catalog both sides can read.

Decisions

What is waiting on each side, and who owns the next move.

Documents and milestones

Working documents and dates. The index points at the governed library; a link is not permission to open it.

Across organizations

The parts that connect a CBO, the plan and each other.

The same architecture that runs a CBO’s day connects it to the plan and to other organizations, without asking anyone to give up their own system.

The exchange layer

The seam between organizations: transaction identity, participants, delivery and return receipts. Organizations exchange referrals and returns without adopting the same software. It carries the exchange, and is not a case record.

Closed-loop referral

Referrals move on the member record inside an organization, and between organizations through the exchange layer, with a receipt each way.

Transactions & Campaigns

The protected plane for member-level campaign work: cohort receipt, work issuance, work lists, exceptions, returned evidence, reconciliation and closeout, with its own storage, permissions and audit.

Approved Guidance

Versioned, approved, inspectable guidance at the point of work. It informs the work; it is not the workflow engine.

See how every product fits in the platform architecture.

Ground rules

What stays true.

Your systems are the record

The plan’s authorization and claims systems stay authoritative. CalLINKS Work does not mirror or compete with them.

The plan decides

Screening is an aid. Eligibility, authorization and payment decisions are yours.

Member information stays put

The partnership surface holds none. Member information lives only where the agreements allow it.

People submit

Packets and claims are prepared and checked here. A person sends them.

Next conversation

Walk a referral through with us.

Pick a real kind of case, a borderline ECM referral or a housing deposit, and we will walk it from screening to the packet your reviewers see, using constructed records.

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