Step 3 — Audit-Ready System
Billing Codes &
Documentation System
Built to withstand DHCS review, managed care audits, and elected-official scrutiny — while remaining clear and usable in day-to-day operations.
Core Documentation Principle (Non-Negotiable)
You are documenting a Medi-Cal service — not a curriculum.
✔ Correct
"Client received behavioral health skills training focused on emotional regulation."
✗ Incorrect
"Client completed B Curriculum session."
Quick Reference
Medi-Cal Billing Codes
All codes already exist in the Medi-Cal system. No new reimbursement categories needed.
Self-Management Education & Training
Individual self-management support. Requires physician order or referral in some plans.
Provider
CHW
30 min
Self-Management Education (Group, 2–4)
Small group format. Great for community settings.
Provider
CHW
30 min
Self-Management Education (Group, 5–8)
Larger group sessions — clinics, schools, community orgs.
Provider
CHW
30 min
Peer Support Services
Covered statewide. Delivered by certified peer support specialists.
Provider
Peer Specialist
15–60 min
Enhanced Care Management (ECM)
CalAIM ECM benefit. Whole-person coordination for high-need populations.
Provider
ECM Lead Care Manager
Variable
Case Management / Community Supports
Coordination and navigation services. Includes housing, food, financial navigation.
Provider
CHW / Care Manager
15 min units
Individual Psychotherapy (60 min)
Standard behavioral health billing. B Curriculum used to structure skills training.
Provider
Licensed Provider (LCSW, Psychologist)
60 min
Group Psychotherapy
Group therapy format. Ideal for skills-based group work.
Provider
Licensed Provider
60–90 min
Every Note
Required Documentation Fields
Every billable note MUST include all of the following.
Service Type (CHW, Peer, ECM, etc.)
Date & Duration
Provider Type (CHW, Peer, Licensed)
Intervention Provided
Link to Treatment Goal
Client Response
Progress Toward Goal
Plan / Next Steps
CRITICAL
Medical Necessity Language
Standard Statement — Use in All Files
"Services are medically necessary to address identified behavioral health needs, including impaired emotional regulation, social isolation, and psychosocial stressors impacting functioning."
Functional Impairment Examples — Use at least one:
Difficulty managing stress or anxiety
Limited coping skills
Social isolation
Financial stress impacting mental health
Difficulty maintaining daily routines
EHR Templates
Progress Note Templates
Copy-paste ready templates for each provider type.
CHW Progress Note
98960 / ECM · 30 minutes
Service Type
CHW Preventive Service
Intervention
Provided self-management support focused on emotional regulation (breathing techniques) and routine stabilization (Balance).
Link to Goal
Supports goal of improving coping skills and daily functioning.
Client Response
Client engaged and demonstrated ability to perform breathing exercise.
Progress
Making progress toward improved emotional regulation.
Plan
Continue weekly sessions and introduce additional coping strategies.
Peer Support Note
H0038 · 45 minutes
Service Type
Peer Support
Intervention
Facilitated recovery-oriented session using emotional regulation strategies and social connection support (Belonging).
Link to Goal
Supports goal of reducing isolation and improving recovery stability.
Client Response
Client actively participated and identified peer support resource.
Progress
Improved engagement and social connection.
Plan
Continue group participation and follow-up.
ECM Note
G9012 · 30 minutes
Service Type
Enhanced Care Management
Intervention
Conducted outreach and care coordination. Addressed financial stressors (Banking) and connected client to community resources.
Link to Goal
Supports stabilization and access to care.
Client Response
Client accepted referral and expressed reduced stress.
Progress
Improved engagement with services.
Plan
Follow up on referrals and continue care coordination.
For Administrators
Pre-Submission Audit Checklist
Confirm all items before submitting claims.
Service Validity
- Covered Medi-Cal service used
- Correct billing code applied
Provider Compliance
- Staff properly credentialed
- Supervision documented
Documentation Quality
- Clear intervention described
- Linked to treatment goal
- Includes client response
Medical Necessity
- Functional impairment documented
- Service addresses need
Billing Integrity
- No duplicate billing
- Time matches service
Defensibility
How This Holds Up Under Scrutiny
State Review (DHCS)
- Uses existing Medi-Cal codes
- Follows CHW & Peer service definitions
- Aligns with CalAIM
Managed Care Plans
- Improves engagement
- Addresses SDOH
- Reduces utilization
Elected Officials
- Preventive model
- Workforce expansion (CHWs + peers)
- Cost-effective
- Community-based
Final Positioning
The B Curriculum is not a new cost, not a new category, and not experimental.
It is a structured way to deliver services California already pays for.