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Health Coverage Information
Medicare Hospital Discharge Appeal Process – Effective 7/1/2007
Beginning July 1, 2007, all Medicare beneficiaries, including those in Aetna's Medicare Advantage Plans (HMO, PPO, PFFS), will be able to request immediate Quality Improvement Organization (QIO) review of an inpatient hospital discharge decision. Under this process, the QIO in the state in which services are provided will perform a third-party binding review of the inpatient hospital discharge decision. For all "timely" Hospital Discharge Appeals, that is, those received before the Medicare member leaves the hospital, the following process will apply:
We will process all "untimely" Hospital Discharge Appeal requests received, that is, those received after midnight on the day of discharge or after the Medicare member has left the hospital. These requests will be subject to the Medicare Expedited Grievance and Appeals Process. For more information regarding the Hospital Discharge Appeal process, please contact us at 1-866-269-3692.
Please also see Hospital Discharge Appeal Notices
on the Centers for Medicare & Medicaid Services (CMS) website.
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