Inpatient admission notification helps in getting your claims paid correctly and on time. Inpatient admission notification isn’t a substitute for prior authorization. Some services require prior authorization in addition to admission notification and
some services don’t require admission notification at all. It all depends on the type of admission and facility. If you have questions, call 877-342-5258, option 3.
For Individual Plan members, call customer service at 800-607-0546.
Inpatient admission notification is required for all acute care hospital admissions and discharges within 24 hours of admission. You can notify us by submitting an admission/concurrent review fax form or through HIE (Health Information Exchange), available to Washington state facilities. The admission also requires medical necessity review. The request for medical necessity review can be initiated by submitting clinical records using the form.
Inpatient admission notification is required for all free-standing hospital psychiatric admissions and discharges.
You can notify us by signing in and using our prior authorization tool or submitting an admission/concurrent review fax form. Be sure to include medical records for admission appropriateness review.
authorization requirements temporarily waived for SNF transfers
Due to the increase in COVID-19 related admissions, we’re temporarily waiving
the prior authorization requirement for skilled nursing facilities (SNFs)
effective September 7, 2021, through October 31, 2021. For documentation, please
provide admission notification and discharge date via fax at 888-742-1487.
Refer Premera members to a contracted facility when possible to reduce member
cost share. To find a list of contracted SNFs, use our provider
directory and search for skilled nursing. Does not apply to FEP.
not a guarantee of payment. Claims for this admission will be paid based on
benefits and eligibility in effect at the time of service. Sign in to
the provider portal to review member benefit limits. Premera reserves the
right to perform a retrospective review of services if claims or payment
Medical records need to be submitted to us prior to discharge and discharge notification is required. Please fax medical records to 888-742-1487.
Medical records may include:
If the patient is transferred from another acute care hospital or is under observation in your hospital, please include:
Some situations make it impossible for providers and facilities to notify us within the specified timeframe. Learn more in our extenuating circumstances policy.
These policies don’t apply to Medicare Supplement or Medicare Advantage members. Learn more about inpatient admission notification for Medicare Advantage members.