Get Mycare Ohio Uniform Authorization Request ... - Lis

Filling out the MyCare Ohio UNIFORM AUTHORIZATION REQUEST ... - LIS form is a crucial step in requesting services for eligible individuals under the MyCare Ohio program. This guide will provide you with clear, step-by-step instructions to ensure you complete the form accurately and efficiently.

Follow the steps to complete the authorization request form online.

1. Click the ‘Get Form’ button to obtain the form and access it for completion.
2. Fill out the top section of the form entirely. Enter the member's name, birthdate, and ID number. Ensure these details match the data in the health maintenance organization's system.
3. Input the primary ICD-9 code related to the skilled services needed or write out the diagnosis for unskilled services. Make sure this code aligns with the assessments and plans of care.
4. Indicate any documents you are forwarding with the request. If both skilled and supportive services are needed, check the box to send a copy to Care Management.
5. Choose the requested services from the four categories: Medicare services, Medicaid state plan home health services, private duty nursing (PDN) services, or waiver services. Provide accurate details for each service needed.
6. In the Medicare services section, specify if skilled services will be rendered, and outline the number of visits required based on the plan of care and orders.
7. For Medicaid state plan home health services, fill out the necessary visits or hours required and select the appropriate boxes for skilled nursing and home health aide services.
8. If applicable, detail the PDN services, including the frequency of care and total hours necessary.
9. Under waiver services, include information about unskilled and skilled services as per the needs of the individual. Select the appropriate frequency and hours.
10. Use the provider comments section to provide additional explanations or specify your agency's contact details, including name, title, department, and extension number.
11. Review all entered information to confirm accuracy. Save your changes, and then download, print, or share the form as required.

Complete your MyCare Ohio UNIFORM AUTHORIZATION REQUEST ... - LIS form online today for efficient processing and support.