راهنمای ارائه دهنده

DRUG AND ALCOHOL SERVICES

• Inpatient Drug and Alcohol Hospitalization
  • Detoxification
  • Rehabilitation
• Drug and Alcohol, Non-Hospital
  • Detoxification
  • Rehabilitation
  • Half-way House

To request authorization for all levels of care listed above, providers are requested to call the Engagement Center and present the required clinical and demographic information. When contacting Carelon for preauthorization, please follow the instructions for conveying clinical and demographic information outlined in the following section, “Information Required for Service Authorization”. These instructions are presented in order, according to the sequential screens of our on-line care management system. Presenting clinical information in this fashion to our Service Managers will result in timely, effective responses to providers’ requests for authorizations.

بررسی همزمان

At the time of the initial authorization, the Service Manager will provide specific instructions to the treating provider for initiating the concurrent review process. Providers should call the toll-free provider number (877-615-8503) on the last covered day to conduct a concurrent review with the Service Manager. Providers will be notified in writing (and telephonically at the time of the review) of the last covered day for payment. If Carelon was not contacted on the last covered day to do a concurrent review, an administrative denial will be rendered.

To approve continued stay requests for inpatient and alternative levels of care, the treatment team member must present the member’s current signs and symptoms and provide detailed information concerning the member’s clinical need for continued care to the Service Manager, including, if applicable, PCPC and ASAM information. Please see “Information Required for Service Authorization” in the following section.

برنامه ریزی تخلیه

Discharge planning begins at the time of admission as a collaborative effort between the Service Managers and the treatment team. Discharge plans should be updated throughout a member’s stay and should be revised as necessary according to the decisions reached in the concurrent review authorization process. Authorization for other levels of care will be based on clinical necessity, current treatment plan and continuity of care issues.