Care Coordination
An approach to care management using proactive methods to optimize health outcomes and reduce risks of future complications over a short-term (two to six weeks) single episode of care.
Concurrent Review of Inpatient Stays
Hospital Notification is a process of reviewing inpatient admissions for discharge needs or to initiate case management services. Refer below for the current Prior Authorization List, which lists all services requiring prior authorization.
Discharge Planning
The goal of discharge planning is to ensure that a client's needs will be met post hospitalization and that they are re-connected with their primary care provider. Such needs may include equipment, specialty follow-up visits and/or community referrals.
Care Coordination for Elective Inpatient Admissions
The goal of care coordination for elective inpatient admissions is limited at this point to surgeries for Total Hip or Total Knee Replacements. The process is to evaluate the request for medical necessity and at the same time conduct a client assessment in an effort to proactively plan for post-surgical complications or care issues.