Providers need to answer these questions on Guiding Care in order to request a pre-authorization for Inpatient Admissions. If you are not a UM manager, please enter as much information as you can and have the UM department update the rest.
Screen One: First Section of Guiding Care
- Who is the provider requesting pre-authorization?
Provider Name: MD requesting service - What is the Request Type?
Medical Inpatient/ OB delivery. If pregnant woman is admitted for other than a delivery please pick Medical Inpatient - Who is the patient requiring the pre-authorization?
First try entering member’s ID number than try patient’s name. Can see if member remains eligible for CCHP when you choose correct member - What is the patient’s diagnosis?
ICD 10 code - What is the procedure code?
This section is left blank for inpatient admission - At which facility does the service need to be performed? (Where are you located at?)
Hospital’s Name
Start Date of Care : include admission date
Requested Level of Care: Inpatient - Who is the attending provider for the service?
Medical Doctor’s name - Are there any other details?
- Please provide the following additional information (Who will the nurses contact?)
Contact Name - UM
Name Contact - UM Phone Number
Contact - UM Fax Number
Screen Two: Authorization Request Review Screen
Each Code will have “Document “, click to open
- Include note for attached clinical or no clinical available
- Attach file-
copy of orders
pertinent medical information
MD progress notes
copies of imaging results
Any records that will help us determine
MAKE SURE TO SUBMIT REQUEST
- Without submitting the request, CCHP will not be able to see the authorization.
Please check your messages to get the information from the UM nurse that is reviewing this episode and they will provide you with their name and phone number and if there is further clinical documentation that is needed that will ask for that here. This is also where you will be informed of the status of the episode.