Admission Notification

  • 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.

    How to submit admission notification

    Type of admission or facility What’s required, what you need to know
    Acute care hospital

    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.

    Free-standing psychiatric hospital

    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.

    Intermediate levels of care
    Long-term acute care hospital(LTAC)
    Inpatient rehabilitation facility/unit (IPR)
    Skilled nursing facility (SNF)
    Residential treatment center (RTC)

    FOR SNF:
    Prior 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 January 16, 2022. 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.

    This is 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 discrepancies arise.

    Prior authorization is required instead of admission notification. To submit your request, you can sign in and use our prior authorization tool or submit an admission/concurrent review fax form. Be sure to submit medical records that support the level of care for the prior authorization request.
    Maternity Inpatient admission notification is not required for the first 48 hours for vaginal delivery and the first 96 hours for cesarean delivery.
    Inpatient admission notification is required for anything beyond these time frames. You can notify us by signing in and using our prior authorization tool or submitting an admission/concurrent review fax form.
    NICU (Neonatal Intensive Care Unit) Inpatient admission notification is not required for babies admitted to a NICU.
    Observation status admissions Admission notification and prior authorization are not required for observation stays, even if greater than 23 hours.
    If the patient’s status changes from observation to inpatient, admission notification review is required, and medical records must be faxed to 888-742-1487 within 24 hours of admission.
    Prior authorization for planned procedures, surgeries All planned procedures, surgeries, and other services require prior authorization and/or medical necessity review and inpatient admission and discharge notification. View our code list for requirements.

    Medical records

    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:

    • Hospital demographic sheet
    • Admitting history and physical, transfer notes, ER notes
    • Medication list, vital signs, labs, imaging, or other diagnostic procedure results

    If the patient is transferred from another acute care hospital or is under observation in your hospital, please include:

    • Specialty consult notes
    • Last 3 days of attending physician and nursing notes
    • Estimated discharge date, discharge plan, and any foreseen barriers to discharge

    Extenuating circumstances

    Some situations make it impossible for providers and facilities to notify us within the specified timeframe. Learn more in our extenuating circumstances policy.

    Medicare Advantage, Medicare Supplement

    These policies don’t apply to Medicare Supplement or Medicare Advantage members. Learn more about inpatient admission notification for Medicare Advantage members.