Non-complex chronic care management is a non-face to face service provided to patients suffering from multiple (two or more) chronic conditions. It is a twenty-minute timed service provided by clinical staff to ensure care coordination among care providers and support patient accountability. The requirements for non-complex CCM include:
• Patient consent.
• Two or more chronic diseases that may last at least 12 months.
• Management of care transitions.
• Personalized care plan in a certified EHR.
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