Dear Provider,

This is a reminder to always include the required documentation for both initial and reauthorization requests. It is imperative that we receive this information at the time of the request to avoid any potential delays in care or increased outreaches to your agency. If we do not receive the required clinicals, our reviewers will outreach for the information - failure to receive a valid order may result in a dismissal of your request.

Documentation for Requests: Below are the documentation requirements that Carelon requires with all authorization requests for contracted, fee for service providers:

• 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

Provider Portal: As a reminder, our provider portal is the quickest and most efficient way to request authorization. If you have not already done so, we encourage you to sign up for the Carelon Provider Portal by clicking here.

If you are not a contracted provider with Carelon, please reach out to our Home Health Provider Relations team and we are happy to provide documentation requirements for your agency.

Please contact the Provider Relations team by email at HHprovider_relations@carelon.com if you have any questions.