Medical Mutual - Health Plans for Life

Documentation Standards, Forms and Policies

Consistent, current, legible and complete documentation is an essential component in quality patient care. A practitioner should be able to act on the patient’s behalf based on the medical record documentation information. With this goal in mind, Medical Mutual encourages practitioners to strive for compliance with the documentation standards, and provides the forms and policies below to assist in these efforts.

Office Site and Medical Record Documentation Standards

Home Health Care Request Forms

CLARIFICATION OF CHANGE IN PRIOR AUTHORIZATION REQUEST – HOME HEALTHCARE SERVICES

There have been changes in our prior authorization for home healthcare services for Commercial members. Currently, prior approval is required for home occupational therapy, speech therapy and home health aide services from the initial visit. This requirement did not change.

Effective April 1, 2018, all skilled nursing and physical therapy visits require prior approval after 120 days from the initial start of care date. For instance, if a member is receiving skilled nursing visits and the start of care date is January 1, 2018, prior approval is not required until May 1, 2018.

Prior approval requests for home care services should be submitted for a 60-day period. If you have already submitted a prior approval request for 2018 via fax and services are ongoing, you should submit requests for additional ongoing visits via NaviNet. For example, if the current certification period is from February 20, 2018 through April 20, 2018, the new request via NaviNet should have a start date of April 21, 2018 and a through date of June 19, 2018.

Please be sure to include the following documentation with all home care requests.

  • Plan of Care or OASIS
  • Notes from the last two visits for each discipline requested
  • Member/caregiver responses to interventions, teaching and training; wound measurements
  • Discharge planning and estimated remaining home care duration for each discipline


To request prior authorization for home health care services access the NaviNet website at navinet.secure.force.com. If you need assistance with NaviNet, please contact NaviNet Customer Service, Monday through Friday, from 8a.m. – 5:30p.m. at 1-888-482-8057 (EST) as well as by voicemail only Monday through Friday from 5:30p.m. – 11:00p.m. & Saturday 8a.m. – 3p.m.

Thank you for your support of this initiative. For more information about this change, please contact your Medical Mutual Provider Contracting Representative.


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