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Acute Care Provider Manual
& Certification Forms
TABLE OF CONTENTS

  

To view the following publications, you will need Adobe Acrobat Reader. To download, click here.

TABLE OF CONTENTS Updated 8/31/05

I. INTRODUCTION TO HSM

  1. Mission Statement I-A (1)

  2. Key Personnel I-B (1)

  3. Overview of Program I-C (1-8)

II. UTILIZATION REVIEW ACTIVITIES - POLICIES & PROCEDURES

  1. Inpatient Acute Care - Medical/Surgical

    1. Precertification II-A-1 (1-4)

    2. Emergency Admissions (Post-Admission) IIA-2 (1-5)

    3. Pre-op Day II-A-3 (1)

    4. OB and Newborns II-A-4 (1-6)
      a. Maternity Admission for Delivery Reporting Policy II-A-4-a (1-3)  
       b. Maternity Reporting Form II-A-4-b (1)
      c. Reporting of Maternity Admissions for Delivery
           – ICD-9 CM Codes II-A-4-c             (1-4)

    5. Concurrent Certification II-A-5 (1-5)

    6. Retrospective Certification II-A-6 (1-5)

    7. Post DC Concurrent Certification II-A-7

       

  2. Swing-Bed Services

    1. Precertification II-B-1 (1-4)

    2. Concurrent Certification II-B-2 (1-5)

    3. Retrospective Certification II-B-3 (1-5)

       

  3. Transplant Services

    1. Transplant Review II-C-1 (1-6)

    2. Pre-Transplant Review II-C-2 (1-4)

       

  4. Acute Psychiatric Inpatient Care

    1. Adult and Adolescent/Child II-D-1 (1-2)

    2. Inpatient Drug/Alcohol Treatment Programs II-D-2 (1-2)

     

  5. Psychiatric Residential Treatment Facility Services

    1. Precertification/Concurrent Certification II-E-1 (1-6)
       

  1. Reconsideration Process II-F (1-4)

     

  2. Provider Certification Non-Compliance Policy II-G (1-3)


III. CRITERIA

  1. Overview III-A (1)

  1. HSM Psychiatric Residential Treatment Facility Criteria III-B (1-3)
     

  2. HSM Swing-Bed Services Criteria III-C (1-3)
     

  3. Pre-transplant Review Criteria – (route to Division of Medicaid’s Web site located at www.dom.state.ms.us)

 

IV. QUALITY ASSURANCE/UTILIZATION REVIEW

  1. Quality Screening Process IV-A (1-2)
     

  2. Inpatient Acute Care Quality Screens IV-B (1-3)
     

  3. Maternity Quality Screens IV-C (1-4
     

  4. 5% Quarterly Quality Sample IV-D (1-2)
     

  5. On-site 5% Quality Sample IV-E (1-5)
     

  6. Hot-line Process IV-F (1-4)
     

  7. Quality Re-review Process IV-G (1-2)
     

  8. Intervention Process IV-H (1-4)
     

  9. QIC – Issue Weighting and Intervention IV-I (1-5)


 

V. PROJECTS

  1. One Day Stay Project V-A (1-2)

VI. FORMS

  1. HSM External Review Forms List VI-A

 
 

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