Update to Shift Care Services/Private Duty Nursing request for review process for GHP Family members

When a GHP Family member requires shift care/private duty nursing services, providers and home health agencies should work with GHP Medical Management to ensure a request for review of any new or additional services is completed within one business day of completion of the admission assessment. Each request is reviewed by GHP Medical Management on an individual basis of need. Reference medical benefit policy MP287 for more information and guidelines for medical necessity.

Request options

For new members already receiving shift care/private duty nursing services:

• Agencies caring for the member should submit the Shift Care Notification Form within five (5) days of any changes in the status of a member receiving shift care services. The form is available on NaviNet and the For Providers section of the website under Resources. Fax form to 570-271-5507.
• Other providers who become aware of any disruption to shift care/private duty nursing services for new members should contact GHP Medical Management immediately to help coordinate services.
• Agencies who can’t accommodate continuing services or discharged member from services due to staffing issues should call GHP Medical Management immediately to help coordinate services. When notified, GHP Medical Management will work with GHP care coordinators to find available covered services for the member.

For members in need of shift care/private duty nursing services for the first time (new to shift care):

• Prescribing providers referring members for initial shift care/private duty nursing services should use the Private Duty Nursing/Shift Care Form to relay patient and provider information GHP Medical Management. The form is available on NaviNet and the For Providers section of the website under Resources. Fax form to 570-271-5507. 
• Prescribing providers do not need an agency to request shift care/private duty nursing services for a member. A referring provider should request authorization and coordination of shift care/private duty nursing services directly from GHP Medical Management. There are two ways to request authorization/coordination directly from GHP Medical Management:
  • Request services through the Cohere at coherehealth.com.
  • Request services by submitting the Private Duty Nursing/Shift Care Form. Fax form to 570-271-5507.
• Agencies who can’t accommodate new patients or have discharged members due to staffing issues should call GHP Medical Management immediately to help coordinate services. When notified, GHP Medical Management will work with GHP care coordinators to find available covered services for the member.
• When a home health agency has been identified as the agency that will staff a new case when initial authorization is received, that agency may assist with the development of the authorization request, and GHP may correspond with that agency for purposes of obtaining all necessary information to support the request, but the requesting prescribing provider must be the one to initiate the authorization request.

For reauthorization requests, the request may be submitted by either the prescribing provider or the home health agency of record that currently staffs the case.