O-11-607 Prior Auth Requests: Obtaining a Copy of a Verbal Order
🎯PURPOSE: This process gives step-by-step instructions for obtaining a copy of a verbal order (such as 485/Plan of Care and/or Add on Discipline) from HCHB. These steps are to be followed for those cases in which a client’s insurance requires a verbal order to be sent as supporting clinical documentation as part of requesting prior authorization.
Note: Different insurances have different documentation requirements – remember to customize the documentation you provide to the specific insurance’s preference.
🔄PROCESS:
| Part One - Identify Status of the Verbal Order (Approval and Provider Signature) |
| Part Two - A: Order is approved and signed by provider |
| B: Steps if order has been approved but has not been signed by provider |
| C: Steps if order has not been approved |
Part One: Identify Status of Verbal Order
Prior to choosing Step A, B, or C of this process, identify the status of the verbal order in HCHB:
1. Navigate to Clinical Input and locate the client’s specific episode tied to the dates of service for which you are requesting the authorization.
2. Open the patient snapshot for that episode by selecting the folder icon.
3. In the lower right area of the snapshot, select View All beside Orders.
4. Viewing the list of orders, scroll to the right to view the columns in the screenshot:
5. The order status can be determined by the following:
| IF | THEN |
|---|---|
| If the Date Approved field is empty, | the order has not been approved by CQS and is currently in HCHB Workflow for Clinical Supervisor, CCS, or Coding. |
| If the Date Approved field has a date entered, | the order has been approved by CQS and was sent for signature. |
| If the Date Signed field is empty, | the order has not been signed by the physician/NPP. |
| If the Date Signed field has a date entered, | the order has been signed by the physician/NPP and has been attached to the chart. |
6. Determine which of these categories below apply to the order in question. Then proceed to follow the steps in the relevant section below.
| A: Order is approved and signed by provider |
| B: Order has been approved but has not been signed by provider |
| C: Order has not been approved |
Part Two
A. If the verbal order has been approved and signed by the provider:
An order in this status may be downloaded from the episode attachments in HCHB.
1. Navigate to Episode Attachments, which can be accessed either from within the Patient Snapshot or from the bottom of the Clinical Input window).
2. Select the document (single-click) and click View.
3. The document will open. Right-click the document and select Print.
4. Print to PDF and save the document.
B. If the verbal order has been approved but has not been signed by provider:
An order in this status may be printed from the orders list in HCHB.
Note: If an order is in this status but the client’s payer requires a signed copy of the 485 for the auth request (and the need to submit the prior authorization request is urgent), reach out to the medical records team at their group email address medrecspec@adarahomehealth.com.
For BCBS Medicare, see more details on the auth request process here
1. While viewing the clients’ orders in HCHB, select (single-click) the specific verbal order.
2. Select Print Order.
3. The document will open. Right-click the document and select Print.
4. Print to PDF and save the document.
C. If the verbal order has not been signed and not been approved:
1. Never utilize an unapproved verbal order for a prior authorization request. There is no circumstance in which it is appropriate to provide an unapproved order as supporting documentation for a prior auth request.
2. Reach out to the Clinical Supervisor to request that review of that verbal order be prioritized.
- Depending on the stage of workflow the order is in, they may need to reach out to the Clinical Compliance Specialists, or to clinicalsupport@adarahomehealth.com to initiate a Rush Coding request.
3. Continue to follow up and track so that the request can be made timely with the approved verbal order.