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POC Supervisory - Payor and Service Rule Combination

New rule hierarchy where a single Payor may have a different day threshold based on a secondary check of the Service Code

Existing Logic of just a Service Code should remain and will not check the Payor

For Example:

  • (Regular Payor Rule) 22/1 Oklahoma Waiver = 180

    • 22/1 Oklahoma Waiver -> (T1019TF)Advanced Personal Care = 90 Days

  • (Regular Payor Rule) 22/4 Oklahoma Waiver (Medically Fragile) = Initial Visit 14 Days and then 180

    • 22/4 Oklahoma Waiver (Medically Fragile) -> (T1019TF)Advanced Personal Care = 60 Days

  • Matthew Cruttenden
  • Jul 14 2023
  • Needs Review
  • Jan 26, 2024

    Admin response

    Supervisory Rules will be updated to allow a Single Service code to have a unique Rule according to the Payor the Authorization is associated too

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