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Mercy Care's Prior Authorization: Therapy and Home Health Request Form has been updated and is now available on our Provider Forms web page. The following items may help expedite your request and care to the member:
- To expedite Prior Authorization requests for Home Health and Outpatient Therapy, please start using the new and updated request form (above).
- When requesting Home Health and Outpatient Therapy, don’t include the number of units per each code, instead, indicate the number of visits per week and the number of weeks.
- If request is for feeding therapy, please indicate that on the request form.
- Always include the most recent clinical notes pertaining to the requested services.
- If this is a continuation of a previous authorization, then provide the authorization number and the last scheduled visit. Include visiting nurse or therapists’ progress notes that demonstrate medical necessity for the additional Home Health or Outpatient Therapy visits.
Special note for DDD members requiring Home Health and Outpatient Therapy services. There are two types of therapies that can be requested for DDD members - rehabilitative and habilitative:
Rehabilitative therapy: restoring a lost skill or previous level of function and maintaining that skill or level of function once it is restored (usually short-term and related to recently acquired functional deficit due to acute illness or injury).
Habilitative therapy: building a skill or functioning level that had not been previously present (usually long-term condition related to congenital illness).
- DDD is responsible for Habilitative therapy for members under age 21.
- Mercy Care is responsible for Habilitative therapy for adults over 21 years of age.
- Mercy Care is responsible for Rehabilitative therapy for all DDD members regardless of age.
- Mercy Care coordinates with DDD on the therapy coverage and only one authorization from either agency will be issued.
There are two types of Home Health services:
- Short-term skilled Nursing Services related to recent illness or injury (such as wound care) which is covered by Mercy Care.
- Long-term skilled Nursing Services related to chronic illness (such as for vent dependent patient, private duty nursing services), which is the responsibility of DDD.
To prevent a delay and unnecessary denials, providers are responsible for obtaining Prior Authorizations from the correct entity. Mercy Care coordinates with DES DDD on all requests for Home Health and Outpatient Therapy services and will notify ordering provider if the requested services are covered by DDD.
Please don't hesitate to contact your Mercy Care Network Management Representative with any questions or comments. You can find this Notice and all other provider notices on our Mercy Care website.
Thanks for all you do!
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