If a member receiving outpatient services needs an inpatient admission, you must notify us as noted above. We may retroactively deny 1 or more days based upon the case review. If notification isn’t provided in a timely manner, we may still review the case and request other medical information. Once we receive your notification, we begin a case review. Online: Use the Prior Authorization and Notification tool at /paan. Maryland facility variations from the standard notification requirements for facilitiesįor information specific to members in Maryland, refer to /priorauth > Prior Authorization and Notification Program Summary > and scroll down. You must verify available benefit and notify us within 1 business day of SNF admission. SNF placements do not require prior authorization. All final coverage and payment decisions are based on member eligibility, benefits and applicable state law. Prior authorization doesn’t guarantee coverage or payment. Payment may be denied to the facility and attending physician for services provided in the absence of prior authorization. But the facility should verify that prior authorization is obtained before the admission. It is the admitting physician’s responsibility to obtain the relevant prior authorization. ![]() Prior authorization is required for all elective inpatient admissions for all M.D.IPA and Optimum Choice members. ![]() Facilities are responsible for providing admission notification for inpatient admissions, even if advance notification was provided by the physician and coverage approval is on file. ET the next business day.įor emergency admissions when a member is unstable and not capable of providing coverage information, the facility should notify us as soon as they know the information and explain the extenuating circumstances. For weekend and federal holiday admissions, notification must be received by 5 p.m. ![]() ET the next business day if 24-hour notification would require notification on a weekend or federal holiday). It is the facility’s responsibility to notify UnitedHealthcare within 24 hours after weekday admission (or by 5 p.m.
0 Comments
Leave a Reply. |