Carelon recently sent out the below notice regarding documentation required; while this is specific to Carelon, it also applies to almost all plans/payers
The Carelon provider portal is the easiest and fastest way to submit for authorization; if your organization does not have a log in to Carelon’s portal, register by clicking here.
Initial Requests: Verbal or signed order, and at least one piece of clinical documentation (H&P, office visit note, discharge summary, etc.)
Reauthorization Requests: Oasis, Plan of Care, clinical documentation (all visit notes, discipline evaluations, wound measurements), and HIPPS code (if available). Once start of care/initial evaluations are completed, all reauthorization requests should have orders that contain the frequency and duration.
Recertifications: verbal or written order, signed Plan of Care, and recert Oasis
ROC’s: Order to ROC and ROC Oasis
Sending in the correct information the first time is key to a smooth and timely process! Carelon | Required Documentation (mailerlite.com)
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