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Home health is defined as services provided in a patient’s home by a home health agency. Home health services include skilled nurse visits, occupational therapy, physical therapy and speech therapy. It also includes intravenous (IV) therapy, total parenteral nutrition (TPN) and home phototherapy.
Refer to the Home Health manual for information about our policies, procedures, and a variety of topics important to home health providers.
Precertification of Home Health Services
When precertification of nursing services is required by the member’s contract, home health providers must verify any requirements. All requests for precertification of skilled nursing services must be reviewed for medical necessity.
To initiate a precertification, call the Health Management Program at 1-800-821-7231 or 205-733-7067 and follow the prompts. Written requests can be faxed to 205-733-7374 or 888-295-3005 within five business days of the initiation of care. Be sure to include the patient’s name, contract number, provider’s name and telephone number, the initial assessment, the physician’s order, and any other pertinent information.
- When a physician recommends home healthcare for a member, follow the procedures outlined below:
- The Home Health Services Request for Certification Form must be completed by the member or responsible party, the physician, or the nursing agency.
- The form must be submitted to Blue Cross and Blue Shield of Alabama via the address or fax number printed on the form within five business days prior to the start of the care.
- The completed form will be evaluated to assess the medical necessity of the proposed skilled nursing services and for their duration and frequency.
- Proposed services will be approved by assigning hours per days, weeks or visits based on the information submitted on the Home Health Services Request for Certification Form necessary for skilled nursing care.
- Notification letters containing the authorization number will be mailed to the member, and faxed to the nursing agency and physician.
- All initial certifications require start of care assessment, plan of treatment, medication list and certification signed by the attending physician.
- All recertifications require nurses’ notes, a new nursing plan of treatment and a new certification signed by the attending physician. The recertification form must be received within five business days after the ending date of each certification period. Nurses’ notes from the proceeding certification period must be attached.
- Services for skilled nursing care may not be certified if the nursing agency or nurse does not follow the precertification/recertification process.
- Do not submit the Home Health Services Request for Certification Form, nurses’ notes or the nursing plan of treatment with the claim.
- The ‘From’ and ‘To’ dates on your claim must match the dates on the certification period.