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Elective Medical Inpatient Authorization Process Change Effective July 15, 2024

Date: 05/14/24

To provide increased flexibility and better align with industry best practices, we are making the following changes to our planned/elective medical inpatient authorization process effective July 15, 2024.

Prior authorizations for planned/elective inpatient services will be approved for professional services by issuing an outpatient (OP) authorization.

  • Elective Inpatient Prior Authorization numbers will now start with the prefix of OP instead of IP (i.e., OP123456789).
  • The authorization will indicate approval at the inpatient level of care.
  • With the approved OP authorization, there will be an authorization time span of 90 days in which the services can be performed.

Authorizations for the inpatient stay (IP authorization) will be processed and issued at the time of admission.

  • There is no need to get an IP authorization prior to the date of service. Services can be rendered any time within the authorization time span.
  • Notification of admission is required within one business day of admit. At the time of admission notification, an additional authorization number for the admission will be provided to the facility with the IP prefix (IP Authorization).

As a reminder, all planned/elective admissions to the inpatient setting require prior authorization. Prior authorization should be requested at least five (5) days before the scheduled service delivery date or as soon as need for service is identified. If prior authorization is not on file at the time of planned/elective admission, the service is considered retrospective, and provider should follow the appropriate retrospective request process.

Thank you for continuing to provide our members with high quality and compassionate care. If you have questions regarding the information contained in this update, please contact your Provider Engagement Specialist. If you need your assigned Provider Engagement Specialist contact information, please contact us at 1-866-595-8133.