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 2020 Individual Plan members, call customer service at 800-607-0546.
Inpatient admission notification is required for all acute care hospital admissions and discharges. You can notify us by signing in and using our prior authorization tool or submitting an admission notification fax 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 notification fax form. Be sure to include medical records for admission appropriateness review.
Currently, we proactively request medical records from providers. We require medical records by 2 pm the following calendar day from the date of admission. Please fax medical records to 888-742-1487. On Mondays, there may be a tight response timeline since we’re working on admissions that occurred over the weekend.
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.