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At this time, the new provider can submit this form to indicate he or she is the new hospice provider.
Processing the paperwork from the original/current provider first ensures that CMCS can authorize the paperwork of the new hospice provider with minimal interruption.
The hospice interdisciplinary team completes this form to specify the plan of care.
The hospice must include all services and supplies within the hospice per diem that are necessary to treat the member's terminal illness and related conditions.
In other words, federal regulations and medical record standards prohibit backdating hospice revocations.
When records are requested, it is important that you send all associated documentation that supports the services billed within the timeframe designated in the written request.
Paperwork requesting disenrollment of managed care members who elect the IHCP hospice benefit must be faxed to (317) 810-4488.
Also, if other insurance and the IHCP reimbursed the provider for hospice care services, the provider was overpaid and must refund the overpayment to the IHCP.
State Form 48731/OMPP 0011 - This form is for reporting a hospice member's terminal illness and related conditions.
This practice is consistent with the timeliness requirement that all forms have the required signatures within 10 business days from the start of a hospice benefit period.
State Form 54896 - For reporting on the terminal illness and related conditions of members 20 years of age and younger, when concurrent hospice services and curative treatment are elected.The hospice plan of care is supervised by the hospice provider and the curative plan of care by other IHCP providers.