2.4.2.2

Documentation Requirements for the Specialist or Subspecialist for a Telephone Consult with the Medical Home Clinician

Specialists or subspecialists must complete and retain the Specialist or Subspecialist Telephone Consultation Form for Non-Face-to-Face Clinician Directed Care Coordination Services-CCP. These records are subject to retrospective review. The supporting documentation must include, but is not limited to the following:

•	The client’s name, date of birth, and Medicaid identification number

•	Start and stop times indicating the consultation lasted at least15 minutes

•	The reason for the call

•	The specialist’s or subspecialist’s medical opinion

•	The recommended treatment or laboratory services

•	The name and telephone number of the clinician providing the medical home

•	Provider information for the specialist’s or subspecialist’s and the clinician providing the medical home