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July 24, 2017

Administratively Necessary Day Reviews

The Medical Care Unit reviews Administratively Necessary Day (AND) requests. The hospital Case Manager, Social Worker, or Discharge Planner faxes the AND Authorization Request Form prior to the participant’s hospital Discharge Date in order to be considered. This Initial Fax is a placeholder and the review is held until Discharge.

At times, a Telligen inpatient stay review is in process simultaneously. Once the hospital contact person knows the Discharge Date, and the Telligen decision, if applicable, a revised AND Authorization Request Form is faxed. The Post Discharge Final Dates are noted and additional supporting documentation is faxed to prove due diligence in attempting placement.

The Nurse Reviewer makes a determination based on IDAPA Basic Plan Rule 16.03.09.400-403. Once completed, the hospital contact can view the outcome (Approval or Denial, and AUTH Number) in the Molina Health PAS portal under “Authorization Status”, or call Molina at (866) 686-4272 for the information. Exceptions to the three day limitation will be reviewed on a case by case basis. 

Swing Bed Requests

Swing Bed Requests are reviewed by the Long Term Care Unit, not the Medical Care Unit. Providers may submit requests by logging onto their Trading Partner Account on the Molina Health PAS portal, and click the “Long Term Care Submission” link, or fax their requests to Molina at (877) 517-2039.

Contacts

Medical Care Unit
Phone: 1 (866) 205-7403
Fax: 1 (877) 314-8779

Molina Health
Phone: 1 (866) 686-4272
Fax: 1 (877) 517-2039

Telligen
Phone: 1 (866) 538-9510
Fax: 1 (866) 539-0365