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.