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.
The information here doesn't apply to Medicare Advantage members. Learn more about inpatient admission notification for Medicare Advantage members.
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. The admission requires medical necessity review. The request for medical necessity review can be initiated by submitting clinical records by either:
- Submitting an inpatient notification request through Availity (this provides the fastest response).
- Submitting an admission/concurrent review fax form.
- Using HIE (Health Information Exchange), available to Washington state facilities. Note: You'll need to submit clinical records through Availity.
|
| Free-standing psychiatric hospital |
Inpatient admission notification is required for all free-standing hospital psychiatric admissions and discharges. This service requires medical necessity review. The request for medical necessity review can be initiated by submitting clinical records by either:
|
Intermediate levels of care
Long-term acute care hospital(LTAC)
Inpatient rehabilitation facility/unit (IPR)
Skilled nursing facility (SNF)
Residential treatment center (RTC) |
Medical necessity prior authorization is required. The request for prior authorization can be initiated by submitting clinical records by either:
|
| 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. The request for medical necessity review can be initiated by submitting clinical records by either:
|
| 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 within 24 hours of admission. The request for medical necessity review can be initiated by either:
|
| 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.
If your planned procedure requires notification or prior authorization for medical necessity review, it can be initiated by submitting clinical records by either:
|
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.