Corrections to N.C. Medicaid Bulletin December 2017- Hospice Policy Updates

<p>With each prior approval (PA) entry beginning with the third and subsequent benefit periods, providers must fax a copy of the Approval Status Inquiry Form, or the NCTracks Web Submitted Request for Hospice Prior Approval Confirmation Page, to DMA at 919-715-9025. DMA requests that providers include their name and e-mail address on the above forms.</p>

Author: Home Care Services/Community Based Services, DMA, 919-855-43

Correction under General Requirements

The correct fax number for the N.C. Division of Medicaid Assistance (DMA) is 919-715-9025.

Clarification under Certification PA Requirements

With each prior approval (PA) entry beginning with the third and subsequent benefit periods, providers must fax a copy of the Approval Status Inquiry Form, or the NCTracks Web Submitted Request for Hospice Prior Approval Confirmation Page, to DMA at 919-715-9025. DMA requests that providers include their name and e-mail address on the above forms.

Update Hospice Document Type Designation Within NCTracks

Hospice providers shall upload all required documents in the NCTracks Provider Portal using the attachment type that corresponds with the documents below:

Document Name

Attachment Type

Election Statement

CONTREAT

Face-To-Face Encounter

PHYSICAN

Physician Plan of Treatment - Order for care and services

TREATPLAN

  • NC Medicaid Hospice Prior Approval Authorization Form (NC DMA-3212)
  • Hospice Recertification of Terminal Illness
  • Physician Plan of Treatment - Order for care and services
  • Supporting clinical documentation (e.g., medical history, nurses’ notes, IDG notes, prognosis; Tools such, as but not limited to, Fictional Assessment Scales, Palliative
  • Performance Scales, Hospice Card, New York Heart Association Functional Classification Tool, Palmetto Eligibility Scale Tool, and Local Coverage Determination.
  • Ensure all health and other records that support the beneficiary have met the specific criteria in Subsection 2.0 of this policy.

MEDREC

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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