Pre-Authorization Process at ARC Addiction Recovery Centre

May 2024 is mental health awareness month!

Initial Steps

The pre-authorization process at ARC Addiction Recovery Centre is a crucial step to ensure that patients receive the necessary approvals from their medical aids for treatment. Our administrative staff assists in obtaining provisional pre-authorization on behalf of the service user. The process begins after the potential service user qualifies based on pre-screening questions. Once qualified, individuals are asked for provisional admission pending assessment by our doctor.

Documentation and ICD Codes

Our staff uses ICD codes associated with substance abuse or dependence when communicating with medical aid pre-authorization departments. If unsure about the specific codes, they provide the client's symptoms to obtain a suitable ICD10 code. After the doctor's assessment, the official diagnosis is made and prescribed detox regimen is arranged (if required), and medication is administered as per the 'medication management' protocol. The official diagnosis is confirmed with the medical aid provider, and the information is emailed to their pre-authorization department within 24 hours.

Provisional Admission and Doctor's Assessment

Upon qualifying for provisional admission, the patient undergoes a nursing assessment followed by the doctor's assessment. If necessary, the patient may be referred to an appropriate facility. The doctor's assessment includes a detailed evaluation of the patient's condition and the prescription of a detox regimen if required. The patient's official diagnosis is then confirmed with the medical aid provider.

Multidisciplinary Team and Comprehensive Assessment

Following the completion of all documentation, a recovery buddy is assigned to the client and the case manager facilitates an introduction to the centre policies and procedures. Immediate scheduling of interviews and assessments with our multidisciplinary treatment team is conducted to develop an appropriate treatment plan. Our team, consisting of various professionals, provides a comprehensive approach to patient care in accordance with the Medical Schemes Act and the 2008 Substance Abuse Act.

Ongoing Evaluation and Individualized Treatment Planning

Regular evaluations of the patient's progress are conducted with necessary adjustments to the treatment plan to ensure effective care. A tailored, evidence-based treatment plan is developed that addresses the patient's specific needs and aligns with the Medical Schemes Act and the 2008 Substance Abuse Act. This ongoing collaboration between the multidisciplinary team ensures that the treatment plan is continually refined to meet the patient's changing needs and progress.

Contact and Support

For more information on the pre-authorization process or to address any concerns, please contact our team at ARC Addiction Recovery Centre. Our dedicated staff is here to assist you every step of the way. Call us at 066 485 6023 or email admissions@arcaddictionrecoverycentre.co.za.

Contact our team today and find out how we can help!

Call us and our team will arrange pre authorization with your respective medical aid

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Areas that we service

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