Our Team - Healthcare Professionals - Innovative Care Management, Inc.

Faxed Clinical Information:

When you fax information, please include the patient information found on our fax coversheet, or provide the following information:

Contact Person/Sender
Name of Office Sending Information
Callback Phone Number
Fax Number
Patient Name
Date of Birth
Member ID Number
Group Name
Requested Service (preferably with CPT codes)
Diagnosis (preferably with ICD-9 codes)
Facility Name
Provider/Physician Name
Date of Service

When sending clinical information, please include the most recent chart notes relevant to the service and diagnosis. If applicable, diagnostic results are also useful. For medical equipment or medications, please include a copy of the prescription. Please provide legible information, preferably typed.

Utilization Review Voice Mail:

When leaving a concurrent review voice mail, be certain to include in your message the following:

Caller Name/Contact Person
Hospital/Facility Name
Callback Phone Number
Patient Name
Date of Birth
Member ID Number
Preauthorization Number

For medical concurrent reviews, include the following information:

Diagnosis or working diagnosis
Acuity level
Description of IV (intravenous) medications or fluids that are ordered
Description of any tubes or lines that are ordered
What diagnostic tests are ordered and what the results are
Any other pertinent information: are they on oxygen? Abnormal Lab values? Pain management?
Plan of care and estimated length of stay

For mental health concurrent reviews, include the following information:

Axis diagnosis (Axis 1-4)
Current GAF (Global Assessment of Functioning scale) and highest GAF in the last year
Current medications and/or medication changes
What group and/or individual therapies the patient is attending and their participation level
If patient is in detox, what are their current physical symptoms
Plan of care and estimated length of stay