What is Principal Illness Navigation (PIN)?
Principal Illness Navigation (PIN) is a care management service for Medicare beneficiaries with serious, high-risk conditions, provided by auxiliary personnel (such as community health workers or patient care coordinators) under the supervision of a billing physician or Non-Physician Practitioner (NPP).
PIN is to help people with Medicare who are diagnosed with high-risk conditions that are expected to last at least 3 months – e.g., Cancer, HIV, Mental health conditions, Chronic Obstructive Pulmonary Disease (COPD), Congestive heart failure, Dementia, Substance Use Disorder (SUD) – identify and connect with appropriate clinical and support resources.
PIN Workflow in Humhealth
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1
Patient Identification and Eligibility
To be eligible, a patient must have one high-risk condition that is expected to last at least three months. This condition can be physical, mental, or both.… Read More -
2
Initial Assessment
An in-person or virtual evaluation must be conducted to identify any barriers to care, understand Social Determinants of Health (SDOH) such as housing, food,… Read More -
3
Create a Personalized Care Plan
A care plan should be developed based on the patient’s medical condition and community needs. It must include clear goals, timelines, and specific recommendations.… Read More -
4
Continuous monitoring and support (monthly services)
Each month, patients should receive support in accessing healthcare and community resources.… Read More -
5
Documentation
All services, including non-clinical support, must be properly documented. This includes details of interactions … Read More -
6
Bill for Reimbursement
Practitioner bills monthly for PIN services (G0023/G0024) … Read More
