What We Need / Medicaid PA Process

What We Need / Medicaid PA Process

Before we can start the PA process, we need the following items

  1. Work Letter For Every Adult In The Home:  Provide a work letter for every adult in the house.  See attached for an example.  We will provide the work letter for the caregiver.
  2. Face To Face Visit With Physician (Doctor Visit):  ${Leads.First Name} (client) must have a Face To Face (F2F or doctor's visit) visit within 90 days of the start of care assessment.  Please have the physician's office fax us a visit note to 317-660-8703 attention Shiloh Tolbert.     
  3. List Of Other Services And Providers:  Provide a list of all other services received by the client and a list of providers for each service
  4. Name Of School (If Applicable):  Provide the school name so we can get the school calendar/schedule if the client is in school.
  5. Completion of Orientation:  Our Orientation (Zoho Trainer Central) and online training (Relias) must be completed.
Once everything above is completed, we will start the PA process.  Below are the steps to our PA process

  1. Recap / Caregiver Onboarding:  We send out this recap email detailing the next steps (You will receive the recap when we start the PA process).  You will receive separate emails inviting you to Zoho Trainer Central (online Orientation platform) and Relias (online training platform).  
  1. Waiting on Physician Referral:  Our Administrative Coordinator faxes over a PA request to your physician.  This can take up to 30 days to receive back (we usually get these back sooner).  We check in weekly with the physician.  During this stage, you will receive a weekly email and text update.  
  2. Physician Referral Received:  Once we receive the physician referral, the assigned RN Case Manager will reach out to schedule the start of care assessment.  To ensure that there are no delays in the process, please make sure to respond in a timely fashion to get the SOC assessment scheduled.
  3. Waiting On Physician Signed Plan Of Care:  Once we complete the start of care assessment, we send the plan of care to the physician to sign off on.    
  4. PA Pending:  When we receive the physician signed plan of care, we submit everything to the state for review.  The state can take up to 30 days to approve, modify, or deny the PA (we generally receive a response sooner, rarely does it take 30 days).     
  5. PA Approved:  Once the PA is approved, your RN Case Manager will reach out to you to finalize the schedule.  We will convert you in our system and we are off and running.

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