IOP & PHP Asking: Number of Worry Excuse You to Pays

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Also Medicare payment having service PHP means concurrent comment having went on exposure beyond initially certification attacks. Aetna, UHC Optum, and you may Magellan most of the require concurrent feedback to possess IOP and you may PHP. Applications that get ready for concurrent comment with arranged clinical descriptions and current ASAM or LOCUS studies rating proceeded authorizations. Concurrent remark articles are usually due twenty four to help you 72 days in advance of the modern agreement expires. Widely known charging mistake for the IOP and you will PHP was double-charging you the fresh for each and every-diem plus the personal concept requirements, and therefore provides quick CO-97 denials. Contained in this a per-diem big date, specific functions is charged alone (pass-because of features) versus breaking the new per-diem bundling.

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Brand new CY 2025 final signal centered long lasting telehealth coverage having behavioral fitness IOP and you can PHP services to have Medicare beneficiaries. Popular whenever concurrent remark are overlooked together with auth ends. Common when ASAM, LOCUS, or payer-particular severity requirements commonly reported at the entryway and also at concurrent review durations. Generate concurrent comment into the IOP and PHP systematic workflow just like the a repeating task, maybe not an activated process triggered by an enthusiastic auth expiration aware.

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