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Initial Long Term Acute Care Facility Authorization Request Former FASTER AUTHORIZATION, PLEASE VISIT: https://providers.carelonmedicalbenefitsmanagement.com/postacute/PLEASE FAX THIS FORM ALONG WITH

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Patients who require specialized medical care over an extended period of time.

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Patients who need ventilator support or intensive rehabilitation services.

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What is initial long term acute?

Initial long term acute is the first report submitted to the relevant authority regarding the status of a patient's long term acute care.

Who is required to file initial long term acute?

Healthcare providers and facilities responsible for the long term acute care of a patient are required to file the initial report.

How to fill out initial long term acute?

The initial long term acute report must be filled out completely and accurately with all relevant information about the patient's condition and care.

What is the purpose of initial long term acute?

The purpose of the initial long term acute report is to provide the relevant authority with necessary information about the patient's status in long term acute care.

What information must be reported on initial long term acute?

Information such as patient's medical history, current condition, treatment plan, and any relevant test results must be reported on the initial long term acute form.

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