提供者手册

药物和酒精服务

• 住院药物和酒精住院
  • 排毒
  • 复原
• 非医院药物和酒精
  • 排毒
  • 复原
  • 中途之家

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.

并发审查

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.

要批准对住院和其他级别护理的继续住宿请求，治疗团队成员必须出示该成员当前的体征和症状，并向服务经理提供有关该成员对继续护理的临床需求的详细信息，包括（如果适用） PCPC 和ASAM信息。请参阅以下部分中的“服务授权所需的信息”。

出院计划

服务经理和治疗团队之间的共同努力是在入院时开始制定出院计划的。出院计划应在会员整个住宿期间进行更新，并应根据并发审阅授权过程中达成的决定进行必要的修订。其他级别护理的授权将基于临床必要性，当前的治疗计划和护理问题的连续性。