If the patient needs to continue care, beyond your current
treatment plan, you have the option of submitting an Extension of care plan (EOC). The following
information is provided to you and your staff to aid in the process
of filling out the EOC. The EOC is a two-page document that should be filled out and faxed
to TRIAD the same day that the patient has been seen. Please fax
care plans to: 866-225-1033
An EOC should be submitted within three business
days of the patient's last approved date of service (for
continuous care) or within three business days of the
patient's date of return to care. EOC's should be submitted for
continued care to a patient beyond thirty days from the approval
date of a current care plan and for patients returning to care after
an interruption of less than ninety days.
The top portion of both pages must be completed with the name of
the primary treating physician providing care to this patient.
Indicate your Tax ID Number, office and fax numbers with area code.
This is important, since all determinations for treatment will be
sent to you at this fax number. Each page must have the patient's
name and Member ID number indicated. Please indicate the date on
which the form is filled out.
The information requested in the EOC must be legibly provided on
the form. If any required field on the form is omitted, or otherwise
illegible, you will receive notice that you have failed to follow
the proper procedure for filing a request for prior approval.
Such notice shall be provided to you within 24 hours of the receipt
of the invalid submission, and shall include a description of the
failure and the proper procedures to follow in order to rectify and
re-submit the request.
You may elect to submit additional information (i.e. medical records)
to Triad Healthcare Inc. for review in addition to the prior approval from (careplan).
Additional documentation is not
required but will be accepted and reviewed by a Triad clinician.
Additional information can be attached to the care plan, or faxed
separately to 866-225-1033.
If you do not receive a response from TRIAD within twenty-four
(24) hours of your submission, please refax or
call TRIAD at
800-409-9081. Please type or print legibly in black ink
throughout the forms
View manual online in pdf (Adobe Acrobat)
format or download the complete manual.
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