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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.
- 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.
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.