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PAP407

Hospital Inpatient Notification


Provider Administrative Policy

Section
Hospital
Policy Date
February 2008
Status/Date
Revised/October 2013
Provider Type(s)
Hospitals   Physician  

Disclaimer

Our provider administrative policies contain information regarding claims submission, reimbursement, and other information in order to achieve an efficient relationship with our providers. These policies are not an authorization or explanation of benefits. Blue Cross of Idaho retains the right to add to, delete from and otherwise modify this policy in accordance with our provider contracts


Policy

Hospital Inpatient Notification

The definition of a hospital inpatient is a member who has been formally admitted as an inpatient and meets inpatient criteria for severity of illness and intensity of service as defined in the Medical Quality Management Standards Program.

Most Blue Cross of Idaho policies require notification in advance of a planned hospital inpatient admission (see PAP241).

Hospitals may submit an online inpatient notification by following these steps:

  1. Access the Web site at bcidaho.com
  2. Select Providers and log in
  3. Select Eligibility & Claims
  4. Select Inpatient to verify if an authorization is already established
  5. If the authorization is not showing in the Status screen, select Authorization Submission
  6. Select Inpatient Notification (Facilities ONLY) to enter patient information
  7. Select Submit when completed
  8. Print the confirmation that displays the reference ID. This will be the cover sheet for your fax when you send required medical records. You will also receive an email with the same reference ID indicating Blue Cross received the authorization request.

Scheduled Admissions
When a member is admitted for an inpatient stay, you must notify our Care Management Department to avoid a non-notification penalty and to determine inpatient/outpatient status. If you know the admission date, communicate it to Blue Cross of Idaho at the time of an authorization. No additional notification is required.

Emergency Room Admissions/Unscheduled Admissions
You must report hospital admissions that result from emergency medical conditions to the Blue Cross of Idaho Care Management Department by bcidaho.com, phone, fax or e-mail. Such admissions do not require a separate notification or referral request from the primary care physician. All medical care received during the inpatient stay will be considered in-network. This also applies to members directly admitted from physician offices and for obstetric deliveries.  See PAP413 for further information.

Physician Inpatient Notification

Admitting physicians may obtain an inpatient notification via online, by phone or fax completed form (see PAP241). Outpatient Prospective Payment System (OPPS) status indicators determine Inpatient vs. outpatient classification.

Please contact the Provider Contact Center or your provider relations representative for details (See PAP100).

Please refer to PAP279 Clinical Criteria.


Policy History

Date Action Reason
October 2013 Revised Added link to PAP279
April 2010 Revised Title change and reference to hospital inpatient authorizations
August 2008 Revised Title change/language clarification
May 2008 Revised Instructional steps added

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