Program Readiness
Service model review, staffing roles, workflow mapping, launch planning, and gap analysis.
CalAIM Consulting for Nonprofits & CBOs
Turn CalAIM requirements into workable operations.
Pursuit of Coverage helps nonprofit and community-based organizations build the workflows, documentation, billing controls, staff training, and infrastructure needed to operate CalAIM programs more consistently.
Why This Matters
Policy is the blueprint. Operations make it real.
Staff need to know what happens at referral, eligibility review, enrollment, authorization, service delivery, documentation, billing, transition, and closure. We help turn those requirements into a usable operating model.
Built for nonprofit realities
Consulting is designed around limited administrative bandwidth, cross-team handoffs, payer requirements, staffing constraints, and the need to protect both mission and reimbursement.
Consulting Scope
From readiness assessment to program rebuild.
ECM Operations
Referral, enrollment, outreach, documentation, recurring requirements, billing logic, transitions, and closure.
Community Supports
Authorization, eligibility, service tracking, provider handoffs, documentation, billing, and controls.
Justice-Involved Services
Pre-release and post-release workflows, release tracking, documentation, Medi-Cal billing readiness, and warm handoffs.
Billing Infrastructure
Code maps, payer setup, authorization controls, claim tracking, denials, reconciliation, and reporting.
EHR / Case Management Design
Forms, fields, status logic, notes, tasks, billing triggers, dashboards, reports, and workflow requirements.
Policies & SOPs
Operational policies, desk guides, role matrices, documentation standards, controls, and audit trails.
Training
Role-based training for care teams, coordinators, billing staff, supervisors, and leadership.
Audit Readiness
Internal reviews to identify inconsistent practice, missing evidence, unclear handoffs, and reimbursement risk.
Engagement Options
Choose the level of support your program needs.
CalAIM Readiness Assessment
A focused diagnostic for organizations preparing to launch, expand, or repair a CalAIM service.
- Workflow review
- Gap and risk analysis
- Billing-readiness review
- Authorization and documentation controls
- Prioritized action plan
Program Workflow Build
Design or rebuild the operating framework connecting program delivery to reimbursement.
- End-to-end workflows
- Policies and SOPs
- Forms, trackers, and templates
- Billing controls
- EHR requirements
- Staff training
Ongoing Program Support
Advisory and troubleshooting support for programs that need continuous operational refinement.
- Workflow troubleshooting
- Denial review
- Policy updates
- Staff coaching
- Audit-prep support
- Leadership recommendations