Recording Service Requests: A request for service may be received via telephone, e-mail, fax, or online. Service requests are documented on the Service Request Form. H The system shall capture all the information in the Service Request Form. Determining Authorization: Deciding whether to authorize a service request based on established criteria or standards (e.g., medical necessity and financial eligibility). For medical necessity, authorization decisions are based on acuity information collected through the Service Request Form. For financial eligibility, authorization decisions are based on determining if a client meets payer or program requirements or thresholds. The system shall support authorizations for treatments H and services. The system support authorizations for inpatient H psychiatric services day treatment, and Outpatient behavioral services. D The system shall provide the ability to list the services for which the client/patient is eligible and authorized to enroll. The system shall maintain and track service H authorizations according to client funding. This will include Medicaid and Medicare and others. H The system shall capture patient financial liability at the time of authorization. H The system permit for the issuance, letter generation, tracking and closing of internal authorizations that the County issues for clients served at County clinics. The system shall permit for the issuance, letter H generation, tracking and closing of authorizations received from health plans and managed care companies authorizing services rendered by JMHC staff. Specifications PRI MU RESP Included Add'l No Comments Cost Determining Authorization: (continued) H The system shall permit for the issuance, letter generation, tracking and closing of authorizations that the agency issues to providers in the provider network
Recording Service Requests: A request for service may be received via telephone, e-mail, fax, or online. Service requests are documented on the Service Request Form. The system shall capture all the information in the Service Request Form. H Determining Authorization: Deciding whether to authorize a service request based on established criteria or standards (e.g., medical necessity and financial eligibility). For medical necessity, authorization decisions are based on acuity information collected through the Service Request Form. For financial eligibility, authorization decisions are based on determining if a client meets payer or program requirements or thresholds. The system shall support authorizations for treatments and services. H The system support authorizations for inpatient psychiatric services day treatment, and Outpatient behavioral services. H The system shall provide the ability to list the services for which the client/patient is eligible and authorized to enroll. D The system shall maintain and track service authorizations according to client funding. This will include Medicaid and Medicare and others. H The system shall capture patient financial liability at the time of authorization. H The system permit for the issuance, letter generation, tracking and closing of internal authorizations that the County issues for clients served at County clinics. H The system shall permit for the issuance, letter generation, tracking and closing of authorizations received from health plans and managed care companies authorizing services rendered by JMHC staff. H Specifications PRI MU RESP Included Add'l Cost No Comments Determining Authorization: (continued) The system shall permit for the issuance, letter generation, tracking and closing of authorizations that the agency issues to providers in the provider network H
SAMPLE-EHR-Requirements-Template-Nov-2012.docx