Good Samaritan Home Care

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  • Senior Care
  • Mommy and Me
  • Provider / Physician
  • Contact US

Good Samaritan Home Care

Good Samaritan Home CareGood Samaritan Home CareGood Samaritan Home Care
Home
Services
  • Senior Care
  • Mommy and Me
  • Provider / Physician
  • Contact US
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Mommy and Me Specialty Care Program

 

Good Samaritan Home Care offers the Mommy and Me Specialty Care Program, designed to support postpartum mothers and mothers caring for children with medical conditions or disabilities. Our program provides in‑home assistance, including infant care support, daily living help, and trained clinical staff for medically complex newborns.

To enroll a patient, a prior authorization is required from the patient’s insurance company. A copy of the approved authorization must be sent to Good Samaritan Home Care before services can be initiated.

Online Submission

Online Submission Instructions for Providers

 

Required Attachments

  • Prior Authorization Approval: Must include the diagnosis code(s) and service codes authorized by the insurance plan.
  • Plan of Care (POC): The POC should outline the mother’s or child’s needs, goals, and recommended level of support.
  • Hours Approved: Please clearly indicate the number of hours authorized per week or per authorization period.

How to Submit Online

Providers may upload all documents securely through our website:

  1. Visit https://goodsamaritans2u.org
  2. Click the Services tab
  3. Select Mommy and Me Specialty Care Program
  4. Use the Online Submission Portal to upload:
    • Prior authorization approval
    • Plan of care
    • Hours approved
    • Any supporting clinical documentation

Once submitted, our team will review the authorization and contact the family to begin scheduling services.

Attach Prior Auth/Clinical
Attachments (0)

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Fax or Email

 Attention: Prior Authorization Team Fax: 484‑939‑8844 Email: support@goodsamaritans2u.org

Fax Cover Sheet copy (docx)

Download

Prior Authorization Request Form (docx)

Download

Plan of Care Form (docx)

Download

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