Get Mynexus Home Health Care Re-authorization Request Form For Reauthorization And Add On-skills For An

This guide provides clear, step-by-step instructions on how to effectively fill out the MyNEXUS Home Health Care Re-Authorization Request Form for Reauthorization and Add On-Skills. By following these guidelines, users will be equipped to complete the form efficiently and accurately.

Follow the steps to complete the form online:

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering the date of the request in the designated field at the top of the form.
3. Indicate the type of request by selecting either 'Standard Request,' 'Retro Request,' or 'Urgent Request'. Ensure you understand that urgent requests should only be made when necessary.
4. Fill in the member's name and date of birth (DOB) in the required sections to identify the individual receiving care.
5. Provide the member identification number (ID#) to relate the authorization request back to the member's account.
6. Enter the name and phone number of the requestor to establish a point of contact regarding the request.
7. For the agency section, include the agency name and the National Provider Identifier (NPI) number, as these are required to process the request.
8. Complete the diagnosis section by entering appropriate codes and descriptions for the member’s condition, detailing primary, secondary, tertiary, and quaternary diagnoses.
9. Indicate the member's residence type from the provided options, such as Independent Living, Assisted Living, Long Term Care, or Private.
10. Detail the agency recommendations or requests, including the discipline, number of visits, frequency, and duration. This information will help align care with member needs.
11. Review the required checklist and attach the necessary documentation, including a signed MD Home Healthcare order and relevant clinical documentation like OASIS or visit notes.
12. Add any comments or notes that may assist in the processing of the re-authorization request before concluding.
13. Upon completion, ensure all information is accurate, save your changes, and utilize the options to download, print, or share the form, as needed.

Complete your MyNEXUS Home Health Care Re-Authorization Request Form online today for a streamlined experience.