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8.3.2.5 Supporting Documentation
Providers must submit supporting documentation with all prior authorization requests. Examples include:
• Admit and discharge records with prognosis, including emergency room records.
•A history and physical completed within six months or a care plan detailing daily activities from a facility or home health agency.
•A letter on the health-care provider's letterhead including the client's primary mode of mobility and diagnosis history.
In hospital-to-hospital transports or hospital-to-outpatient medical facility transports, the TMHP Ambulance Unit considers information by telephone from the hospital. Beginning June 1, 2005, providers are no longer required to fax medical documentation to TMHP; however, in certain circumstances, TMHP may request the hospital fax the supporting documentation. Hospitals are allowed to release a client's protected health information (PHI) to a transporting emergency medical services provider for treatment, payment, and health-care operations.
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