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Print Form CommunityHealth Care Collaborative (CCC) at HRHCareClear formHealth Home Referral Form CCC is a NYS Department of Health designated Health Home (HH). Our program provides community based
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01
To fill out the CCC Health Home member form, follow these steps:
02
Obtain the CCC Health Home member form from the appropriate source.
03
Read the instructions provided on the form carefully.
04
Fill in all the required personal information of the member, such as name, age, gender, contact details, etc.
05
Provide information about the member's medical history, including any existing conditions or diagnoses.
06
Include details about the member's primary care provider and any other healthcare professionals involved in their care.
07
If applicable, provide information about the member's insurance coverage or healthcare plan.
08
Review the form to ensure all the necessary information is accurately filled in.
09
Submit the completed form as per the instructions provided, whether it is through mail, fax, or online submission.
10
Keep a copy of the filled-out form for your records.
11
If you have any questions or need assistance, contact the appropriate healthcare or CCC Health Home representative.

Who needs ccc health home member?

01
CCC Health Home membership is designed for individuals who meet certain criteria and require additional coordinated healthcare services.
02
The following individuals may need CCC Health Home membership:
03
- Individuals with chronic or complex medical conditions requiring ongoing care and support
04
- Individuals with multiple healthcare providers and medications that need coordination and management
05
- Individuals with mental health or substance abuse issues in addition to physical health needs
06
- Individuals who may benefit from care management, care coordination, and support with accessing healthcare services
07
- Individuals who may be at risk of hospitalizations or emergency room visits due to their health conditions
08
Overall, CCC Health Home membership is intended for individuals who could benefit from comprehensive and coordinated healthcare services to improve their overall health outcomes.
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CCC Health Home Member is an individual who is enrolled in a Medicaid managed care plan and has been identified as needing additional care coordination services.
Healthcare providers and managed care organizations are required to file CCC Health Home Member information.
CCC Health Home Member information can be filled out electronically through the designated portal provided by the state Medicaid program.
The purpose of CCC Health Home Member is to ensure coordinated care for individuals with complex medical needs and improve health outcomes.
Information such as demographics, medical history, care plans, and services provided must be reported on CCC Health Home Member.
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