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Also Medicare percentage for solution PHP requires concurrent comment to own proceeded coverage past very first certification periods. Aetna, UHC Optum, and you will Magellan all of the need concurrent remark to possess IOP and you will PHP. Apps one to prepare for concurrent feedback having organized medical descriptions and most recent ASAM otherwise LOCUS reviews score continued authorizations. Concurrent remark articles are usually owed twenty-four so you can 72 occasions prior to the modern authorization expires. The best recharging error into the IOP and you may PHP is actually twice-battery charging the new each-diem additionally the individual tutorial rules, and therefore produces quick CO-97 denials. Inside an each-diem big date, particular characteristics are recharged on their own (pass-through attributes) versus violating the brand new for each-diem bundling.
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The fresh new CY 2025 last code situated long lasting telehealth publicity having behavioural health IOP and you will PHP properties getting Medicare beneficiaries. Preferred when concurrent feedback is missed therefore the auth ends. Typical when ASAM, LOCUS, or payer-particular seriousness requirements are not noted at admission and at concurrent remark intervals. Make concurrent opinion into the IOP and you will PHP clinical workflow since the a continual activity, maybe not a reactive process brought on by a keen auth expiration aware.
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