![]() Services delivered within the initial 10 calendar day period (counting from start of care visit date of service) will be authorized.The care plan should contain any services already delivered (at least the start of care visit, but possibly more) and those future services that will be required.After the start of care visit has been conducted, compose a care plan for the entire 60 day certification period:.Visit the HPSM member to start care and conduct an assessment within 48 hours of receiving a physician’s order.Caring For Homebound Members To request home care visits: Utilization Management (UM) is unable to make corrections on denied authorizations. We encourage providers to submit initial requests within seven calendar days from the start of care visit. This should alleviate duplicative start of care visits. Please coordinate and confirm with the referral source that orders have been received and the start of care visit will be scheduled within a reasonable time after hospital discharge. The treating practitioner has ordered a change in treatment and frequency.A change in condition (including a new event requiring skilled care).A correction request is appropriate when the following have been identified: We ask that providers submit requests according to the clinical need/clinical presentation of the member based on assessment. Learn more about prior authorizations Correction Requests Complete and submit a Prior Authorization Request Form.Check the Prior Authorization Required List to see if the service requires prior authorization.Please note that authorizations are created per certification period. All services requiring prior authorization must be authorized before providing the service except for services that are necessary on an emergent or truly urgent basis. Unique authorization rules apply for some home health care services. Recertification visit is done during the last five days of the previous certification period. ![]() For a re-authorization request (recertification), submit a Narrative Report/Summary of Recertification Visit.For an initial request, submit a Narrative Report/Summary of SOC Visit.To qualify a member for home health care services, you must submit these documents: ![]()
0 Comments
Leave a Reply. |
Details
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |