Pre-Certification Guidelines - Extension of Care
If the patient needs to continue care, beyond your current treatment plan, you will need to submit an Extension of care plan (EOC). The following information is provided to you and your staff to aid in the process of filling out the EOC to permit pre-certification for treatment. The EOC is a two-page document that should be filled out and faxed to TRIAD the same day that the patient has been seen. Please fax care plans to: 866-225-1033
An EOC will need to be submitted within three business days of the patient's last approved date of service (for continuous care) or within three business days of the patient's date of return to care. EOC's must be submitted for continued care to a patient beyond thirty days from the approval date of a current care plan and for patients returning to care after an interruption of less than ninety days.
The top portion of both pages must be completed with the name of the primary treating physician providing care to this patient. Indicate your Tax ID Number, office and fax numbers with area code. This is important, since all certifications for treatment will be sent to you at this fax number. Each page must have the patient's name and Member ID number indicated. Please indicate the date on which the form is filled out.
The information requested in the EOC must be legibly provided on the form. If any required field on the form is omitted, or otherwise illegible, you will receive notice that you have failed to follow the proper procedure for filing a request for pre-certification. Such notice shall be provided to you within 24 hours of the receipt of the invalid submission, and shall include a description of the failure and the proper procedures to follow in order to rectify and re-submit the request.
Additional Information for Pre-service care requests
You may elect to submit additional information (i.e. SOAP notes) to Triad Healthcare Inc. for review. Additional documentation is not required but will be accepted and reviewed by a Triad clinician. Additional information can be attached to the care plan, or faxed separately to 866-225-1033.
If you do not receive a response from TRIAD within twenty-four (24) hours of your submission, please refax or call TRIAD at 800-409-9081. Please type or print legibly in black ink throughout the forms
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