Skilled Nursing Facilities

This page is used by staff working at Skilled Nursing Facilities contracted Optum Public Sector San Diego. Skilled Nursing Facility staff can obtain forms, protocols, and other documents that support their work with the County of San Diego clients residing Skilled Nursing Facilities.

Application

Name Description Date
*
2018-05-10

Forms

Name Description Date
* Claims UB04 Example Form.pdf
2018-05-10
* Disbarment and Exclusion Attestation Form.docx
2018-05-10
* SF-LTC Bed Hold Request Form.pdf
* SF-LTC Concurrent Review Guide for County Funded SNF.pdf
2018-05-10
* SF-LTC Concurrent Review Process for County Funded SNF.pdf
2018-05-10
* SF-LTC Discharge Process For County Funded SNF.pdf
2018-05-10
* SF-LTC Documentation Needed for Referral For County Funded SNF.pdf
2018-05-10
* SF-LTC Mini-Cog Exam.doc
2018-05-10
* SF-LTC Referral Process for County Funded SNF.pdf
2018-05-10
* SF-LTC Referral Screening Form.doc
2015-10-09
* SF-LTC Referral Screening Form Tips.pdf
2018-05-10
* SF-LTC Request for Admin Days.doc
2018-05-10
* SF-LTC Tips for Completing Referral Screening Form.doc
2018-05-10
* SF-LTC Verification of Admission and Request for Initial Authorization to SNF.pdf
2018-05-10
* SF-LTC Notification of Return to County Funded SNF From Bed Hold.pdf
2018-05-10
* SERIOUS INCIDENT RCA WORKSHEET 1-1-11.doc
2015-11-05
* SF-LTC Notification to Optum of Discharge From County Funded SNF.doc
2018-05-10
*
2018-05-10
* LTC Facilities receiving County Funds for San Diego Clients are required to submit the following information from the client’s case manager when requesting authorization for continued stay
2015-10-09

Manuals

Name Description Date
* Skilled Nursing Facilities Handbook - 3rd Edition.pdf
2016-08-01