The DEEOIC will authorize and pay for in-home health care claimed under the EEOICPA so long as the care has been determined to be medically necessary. The DEEOIC will pay for approved periods of care by a registered nurse (RN), licensed practical nurse (LPN), home health aide (HHA) or similarly trained individual, subject to the pre-authorization requirements.
Obtaining pre-authorization for in-home health care services simply means that you must first be approved for services by the DEEOIC prior to receiving the services. This process starts with making a claim for in-home health care services.
The first step to be able to obtain in-home health care services is to file a claim under the EEOICPA. To file an initial claim for in-home health care you must submit Form EE-17A to the DEEOIC and identify your treating physician.
Upon receipt of your claim, the DEEOIC will contact your treating physician and provide them with the Form EE-17B. Your treating physician will then complete the Form EE-17B which and forward the completed form along with a letter of medical necessity supporting your need for home health care.
Once the DEEOIC receives the documentation from your treating physician they will review and make a decision on your claim. Typically, at this point, if your treating physician provided the necessary information and documentation to support their order for in-home health care, the DEEOIC will issue a decision approving your claim for in-home health care services.
The DEEOIC will reach out to you at this point and find out what enrolled in-home health care provider you would like to provide you with your care. At that time, the DEEOIC will issue an authorization for your selected provider to bill the DEEOIC for services rendered per your treating physician’s orders.