Prior Approval Items- PDN
Prior Approval Items- PDNThe Prior Approval Items tab for PDN (Private Duty Nursing) requests allows you to input service lines identifying the services that are being requested for the patient. The main body of the tab contains an arrangement of fields with each row representing a requested service line. The following fields are displayed:
Line: The line number of the request. You may not change this field. Note that the request line numbers and the subsequent claim line numbers do not have to match.
Service Date: The estimated or proposed date that the requested service is to be performed. May be less than, greater than or equal to the current date.
Item/Proc & Modifier: The HCPCS procedure code and the procedure code modifier.
Req'd Quantity: The requested units of services.
Req'd Amount: The requested dollar amount of services.
More Details: This field navigates you to the More Details view of the line.
Remove: This field removes the line from the request.
The More Details view of a line provides a mechanism for you to add more detailed information about a requested line. The component displays the following fields:
Line, Service Date, Item/Proc & Modifier, Req'd quantity, Req'd Times, and Req'd Amount: These fields display the information that was entered on the previous page. The data may not be modified from this tab.
The Pattern of Delivery section contains fields used to define units of service to be provided over specific periods of time. The following fields are provided:
Service Units & Type: These fields include a service units on the top and a type field on the bottom. The type field is a drop-down that allows you to choose either Days, Units, Hours, Month, or Visits.
Frequency Period: These fields include a frequency value on the top and a frequency type field on the bottom. The type field is a drop-down that allows you to choose either Days, Months, or Weeks.
Duration of Service: These fields include a duration value on the top and a duration type field on the bottom. The type field is a drop-down that allows you to choose either Hour, Day, Years, Episode, Visit, Month, Week.
Calendar Pattern: This field establishes the frequency (e.g., 1st Week of the Month) that the requested service is to be rendered as it relates to calendar days/weeks.
Time Pattern: This field establishes the time (e.g., 2nd Shift) that the requested service is to be rendered.
The Home Health Care section provides fields to document the requested home health care services. The section contains the following fields:
Prognosis: This field captures the patient's prognosis (Good, Fair, etc.) and can be populated by the associated pop-up.
Start Date: The date that the home health care is to begin.
Skilled Nursing Facility: The drop-down establishes whether the patient was or is to be discharged prior to the start of the home health care.
Medicare Coverage?: The drop-down establishes whether or not the patient has Medicare coverage.
Certification Period: These From and To dates establish the period within which the home health care is certified.
Related Surgery Date: The date of a surgery, if any, related to the home health care.
Related Surgical Procedure: These radio buttons and related text field capture whether the procedure is a HCPCS or a ICD-9-CM procedure and the procedure code, respectively.
Physician Order Date: The date that a physician ordered the home health care.
Last Visit Date: The date that the physician last saw the patient.
Physician Contact Date: The date that contact was last made with the physician.
Admission Period: These From and To dates establish admission and discharge dates, if any, from a facility prior to start of home health care.
Discharge Facility Type: The type of facility (e.g., Acute Care Facility) from which the patient was or will be discharged prior to the home health care.
This group allows you to apply attachments to a line. The Enter More Attachments link allows for the entry of 5 additional attachment fields.
Copy attachments from Line: Allows you to apply attachments used in another line to the current line.
Type: This field can only be populated by the associated pop-up and identifies the type of attachment.
Transmission Code: This field can only be populated by the associated pop-up and identifies the method by which the attachment will be transmitted to eMedNY.
Control Number: This field identifies the attachment's control number in your records. It is an internal number that is for the provider's office use only and does not correspond to the subsequent PA number issued by NYS Medicaid.
Description: This field describes the attachment.
The Comments field allows you to enter free form text that clarifies the request. You may copy comments into the current line from another line in the current PA.
After you have completed the additional items for the current line, choose Close to save the information and return to the previous page. If you wish to abandon the additional items for the current line, choose Clear and you will return to the previous page.