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December 2016 Texas Medicaid Provider Procedures Manual

Home Health Nursing and Private Duty Nursing Services Handbook : 4 Private Duty Nursing (PDN) Services - CCP : 4.1 * Services, Benefits, Limitations, and Prior Authorization : 4.1.4 Authorization Requirements : 4.1.4.14 Start of Care (SOC)

4.1.4.14
The SOC is the date that care is to begin, as agreed on by the family, the client’s physician, and the provider, and as listed on the POC and the CCP Prior Authorization Request Form. Providers are responsible for determining whether they can accept the client for services.
Once the provider accepts a client for service and accepts responsibility for providing PDN, the provider is required to deliver those services beginning with the SOC date. Providers are responsible for a safe transition of services when the authorization decision is a denial or a reduction of services. Providers are required to notify the physician and the client’s family on receipt of an authorization, a denial, or a change in PDN.
Providers must submit complete documentation no later than three business days from an SOC date to obtain initial coverage for the SOC date.
Note:
For PDN recertification, CCP must receive complete documentation no later than three business days before the SOC date. It is recommended that recertification requests be submitted up to 30 days before the current authorization ends.
During the prior authorization process for initial and recertification requests, providers are required to deliver the requested services from the SOC date.

Texas Medicaid & Healthcare Partnership
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