Hello everyone,
Our primary Dr for one of our facilities is going to be out in a few days for a month and I am trying to make sure we are hitting all the marks with Optum to avoid any claims issues. I have called and spoken to multiple people there that all have a different explanation or suddenly end up out of the office for weeks at a time. I'm trying to figure out what their minimum requirements are for RTC and PHP treatment of Mental Health, Substance Abuse, and Eating Disorders. Has anyone been successful with getting a list of what they specifically want as far as what assessments they want and how often they need to be done? So of course the patient needs a physical, biopsychosocial, and a psychiatric eval within the first 24 hours- but what else do they want? And who can do it? Can we use an APRN or a LCSW? Or does most of it require a Therapist or Psychiatrist?
I appreciate anyone's input because at this point Optum has referred me to LOCUS (which is vague, and obviously not their only requirement based on claim denials) or on another occasion their retired Level of Care Guidelines.
