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Timely notification required

 

 

To comply with our inpatient timely notification requirements, be sure to notify us of hospital admissions within one business day.* Failure to comply means that charges could be subject to a denial of up to a maximum of $10,000.

 

Also note:

 

  • You must precertify maternity or newborn confinements, if they exceed the standard length of stay of three days or less for vaginal or five days or less for caesarean.
  • You must contact us if notification is late or if you've discharged the patient.

*Maine, Pennsylvania and Indiana allow alternate time frames for notification.

 

Extenuating situations

 

There may be reasons why patients can't provide coverage information. Note the following guidelines regarding how we handle extenuating situations:

 

  • If you notify us within 14 days after the patient's discharge, we'll make a decision based on the information we have.
  • If you notify us after 14 days from the patient's discharge, we'll note your contact. Examples of supporting evidence we may consider upon appeal include:
    • ID card/eligible information was obtained before/during admission
    • Facility face/demographics sheet (contains patient demographic information)
    • Records confirming contact with another carrier before/during admission

We'll review all available information when making an appeal decision.