Prior Authorization : Plan of Care

Case Sharing Prior Authorization Responsibilities

When two or more PDN providers share a case, it is necessary for the RN who receives the physician's orders to complete Elements 24 and 25 of the PA/CPA.

Each NIP sharing the case is required to obtain a copy of the POC for the effective certification period and countersign and date POC as instructed for Elements 31 and 32 of the PA/CPA. The nurse's countersignature is required to document that they have reviewed the POC and will execute it as written. The countersigned document is a copy of the physician-signed document. The countersigned copy of the POC must be retained with the provider's records.

For each certification period that the countersigning nurse provides services, they are required to countersign and date the POC as instructed for Elements 31 and 32 the PA/CPA before providing services. A nurse may obtain a copy of the POC and countersign and date Elements 31 and 32 of the POC after the certification period "From" date indicated in Element 4; however, the nurse may not submit claims for services provided before the date they countersigned the POC.

When a PAL requests PA but is not the PDN provider designated to receive the physician's orders requests PA, the PAL is required to submit a countersigned and dated copy of the POC with the PA/RF.

The PDN provider designated to receive the physician's orders is not required to keep copies of any POC countersigned by the other nurses. Each provider is required to retain only their own documentation.