Authorization of Care (Provider to payer information flows)

Use Cases involving providers sending information required by payers during care

Use Case Posting:

Managed Care Authorization for Home Care Agency: While caring for a patient who is covered by a managed care company, a home care agency may be required to send authorization information to that managed care company. This may include functional status information. The authorization could be coded in a CCD with the functional status information (RN).

Managed Care Authorization for Skilled Nursing Services: Similar to above, but patient is a resident in a skilled nursing facility.