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.

    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. To notify us of an inpatient admission, complete an admission notification fax form.

    Free-standing psychiatric hospital

    Inpatient admission notification is required for all free-standing hospital psychiatric admissions and discharges.

    To notify us of an inpatient admission, complete an admission notification fax form and 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)
    Prior authorization is required instead of admission notification. Use the admission notification fax form and 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.
    NIC (Neonatal Intensive Care Unit) Inpatient admission notification required for all babies admitted to a NICU. Submit an admission notification fax form.
    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 Some 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

    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:

    • 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.