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The LTACH Assessment Form is a comprehensive document designed for long-term acute care hospitals (LTACHs) to collect essential information about a member's medical history, current health status, and rehabilitation needs. It includes sections for member and hospital details, clinical information, rehabilitation therapy assessments, discharge plans, and requirements for placement in an LTACH. The form emphasizes the need for prior assessments by skilled nursing facilities before considering LTACH placement.

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We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

What is the phone number for Blue Advantage prior authorization?

Use the Precertification Lookup Tool accessed through Payer Spaces in Availity. Call Provider Services at 1-844-421-5662.

What is the phone number for Blue Shield Promise authorization?

You may review our medical policies online or contact Provider Services at (800) 468-9935, 6 a.m. to 6:30 p.m., Monday through Friday.

What is the phone number for eviCore authorization?

eviCore healthcares prior authorization call center is available from 8:00 a.m. to 9:00 p.m. Eastern Standard Time, Monday through Friday. The phone number is (888) 693-3211. The web portal is available for access 24/7.

What is the phone number for BCN authorization?

A HIPAA authorization form, also known as a HIPAA release form, is a document that individuals sign for their health provider before the entity may use or disclose their protected health information (PHI). HIPAA authorizes the sharing of PHI for the following purposes: Treatment. Payment.

What are Hipaa authorization forms?

Primary care providers should submit global referral requests to BCN through the e-referral system. For more information, see the e-referral User Guide. Health care providers must follow the global referral requirements that apply to the region in which their medical care group is headquartered.

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How do I submit a global referral to BCN?

What is an Authorization Form? An authorization form is a document that is duly endorsed by an individual or organisation which grants permission to another individual or organisation to proceed with certain actions. It is often used to grant permission to carry out a specific action for a fixed period of time.

What is the phone number for centralized authorization file?

PPS may be reached at 866-860-4259. A PPS assistor will initiate the process to help you retrieve your CAF number once you provide your authenticating information.