Get Mynexus Home Health Care Re-authorization Request Form For Reauthorization And Add On-skills For An 2016-2025

Filling out the MyNEXUS Home Health Care Re-Authorization Request Form can seem daunting, but with the right steps, it can be a straightforward process. This guide provides clear, step-by-step instructions to help users complete the form accurately and effectively.

Follow the steps to successfully complete your form.

1. Press the ‘Get Form’ button to access the document and open it in your editing tool.
2. Begin by entering the date of the request at the top of the form. Indicate whether this is a standard, retro, or urgent request.
3. Fill in the member’s name, agency, date of birth, NPI, and member ID number. Ensure all required fields are completed accurately.
4. Provide the requestor's name and email address, along with the member's state of residence and contact information, including a phone number and fax number.
5. Indicate the authorization number if available, and answer whether the caregiver is able, willing, and teachable.
6. Specify the start of care date and include any relevant explanations if applicable.
7. List the plan of care physician or nurse practitioner’s name, phone number, and NPI.
8. Detail the member’s diagnosis, including relevant codes and descriptions.
9. Select the primary, secondary, tertiary, and quaternary residence by checking the appropriate boxes.
10. Fill out the agency request section with certification period dates, the discipline needed, the number of visits being requested, and frequency as per the plan of care.
11. Ensure to complete the required checklist by providing a verbal or signed order for new skills, an OASIS for the first re-authorization request, and updated clinical documentation.
12. Review all entered information for accuracy. After confirmation, you can save the changes, download, print, or share the completed form as necessary.

Complete the MyNEXUS Home Health Care Re-Authorization Request Form online today to ensure timely processing of your request.