Louisiana Healthcare. Connections

Transcription

1 Louisiana Healthcare Third level Connections Outpatient/Home Health OT, PT or ST Treatment Request

2 OTR Essential Elements Member Information Ensure Member name written on the form is the same as it is on the ID Card Include hyphenated names Be certain Third the level first name is not a nickname Double check Medicaid Number

3 OTR Essential Elements Provider to Perform the Service Referring Provider: Be certain to enter the physician who did the referral Plan of Care (POC) requirements are as follows: Home Health: Must be updated and signed every 60 days EPSDT: Second Must be updated level and signed every 6 months Outpatient Hospital: Unlimited time frame after initial Third level If POC is out Click of Fourth date, to edit level new Master POC subtitle is required style for authorization Referring provider must sign one of the following: POC Prescription

4 Common Errors Provider Section Incorrect NPI Number used for provider Referral not updated Incorrect Referring Third level Provider information Referring Provider phone number listed inaccurate

5 Make sure to utilize ICD-9 codes Third level Ensure Diagnosis Click Fourth to fits edit level with Master Plan of subtitle Care style OTR Essential Elements Diagnosis/Disorder The diagnoses are those for which you are providing rehabilitation (i.e. OT, PT, ST)

6 Avoid overlapping Third level or redundant goals Coordination of services is a must OTR Essential Elements Services Provided in School Setting Attachment of an IEP is very important to determine coordination between schools and provider

7 OTR Essential Elements Medical Conditions/Treatment Include co-occurring diagnosis Make sure to utilize ICD-9 codes Ensure Diagnoses pertain to what you are treating in Third level Plan of Care (e.g. Botox injections for patient being Click Fourth to edit level treated for spasticity) Master subtitle style

8 Common Errors Diagnosis and School Services Improper diagnosis Diagnosis changes with new request for same condition Provision of therapy Third level in school setting section is left blank Therapy is being provided in the school setting, but no information is provided related to focus of treatment

9 OTR Essential Elements Requested Evaluation/ Re-Evaluation Authorization Pre-Authorization is required for Evaluations and Re- Evaluations when: The provider is non-par The provider is par, but is requesting: 2 nd evaluation for the same discipline 2 nd re-evaluation in a year for the same discipline Start and End Third Dates level Authorizations will not be retroactive, unless there is a valid reason for the delay Fifth in submitting level the request Retain a copy of fax confirmation sheet Service Location

10 Common Errors Evaluations/Re-Evaluations Multiple Initial Evaluations billed by same Provider Authorization Start Date section filled in with date that is prior to date Third submitted level

11 OTR Essential Elements Treatment Requested Date Treatment Started Frequency can be captured in times per month or times per Click week to edit Master text styles Total Visits Requested Third level should be a total number for the span of the authorization Start & End Dates Span End of coverage

12 Common Errors Treatment Requested Date Treatment Started (anything other than Initial Eval. Click date to for edit the same Master diagnoses/deficits) title style Frequency documented as a range (e.g. 1-3/week) Frequency or duration on OTR is significantly different than on the Third POC level and there is no explanation Frequency/Duration on POC and OTR are not followed once treatment has begun Dates of service on OTR do not match the dates on the POC

13 Objective Goals are SMART, not Vague (be SMART) SPECIFIC Goals/Interventions MEASURABLE Third level ATTAINABLE REALISTIC TIMELY Plan of Care Measurable Goals/ Objectives/Interventions

14 Plan of Care Key Elements Diagnosis with date of onset or exacerbation Standardized Evaluation scores, and include: Documentation of age equivalency Percent of functional delay Standard Second Deviation level (SD) score when appropriate for the Members diagnosis/disability Third level Short and long term treatment (SMART) goals Treatment techniques and interventions to be used Summary of results achieved

15 No objective measurements of deficits Third level No objective Click measurements Fourth to edit level Master of subtitle improvement style Common Issues POC: Objective Measures Standardized Click to edit developmental Master title scores style are within normative range Standardized Evaluations utilized for appropriate population All objective measurements have not been administered to rule out concomitant diagnoses

16 Third level Common Issues Plan of Care Clinical information submitted does not support the frequency of requested services Frequency or duration of visits are not supported by the severity of deficits No updated clinical information or progress notes to support reauthorization of services Use outdated ICD codes Goals are written for deficits that are not documented Deficits are documented and treatment plan does not address deficits

17 Requesting services that appear to be more appropriate in the school environment. Examples include goals for: Handwriting Reading Telling time Common Errors POC: School Based Services Written language Third level There is no evidence Fifth that level therapies are being coordinated between private and school based therapists

18 Submitting your OTR Frequently Asked Questions Q: What? A: OTR form, Plan of Care, Prescription, and IEP (if services are being coordinated with school) Q: When? A: After completing Third level an initial evaluation or at end of an existing authorization period Q: Where? A: Completed OTRs are faxed to (855)

19 Important Contact Information Louisiana Healthcare Connections Website: www. Medical Necessity Criteria: www. Louisiana Healthcare Connections Phone Number: (866) Third level Cenpatico Fax Number: (855) Claims Phone Number: Fifth (866) level Claims Address: PO Box 4040, Farmington, MO