New Claims System Update

6.7 Hospital Services

Provider Manual
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6 PROVIDER NETWORK INFORMATION

6.7 Hospital Services

There are two types of admissions:

  • Elective inpatient admissions — precertification is required for all       elective inpatient admissions
  • Emergency admissions — admitting physicians must notify us        within 24 hours or by the next business day of the admission

    • IntegraNet, in coordination with admitting physicians and hospital-based physicians:

  • Coordinates and conducts continued-stay coverage reviews.
  • Provides appropriate referrals for extended-care facilities.
  • Approves coverage of all services required for adequate discharge.

    • IntegraNet case managers assist in coordinating all needed services in the discharge planning process, as well as coordinating the required follow-up by the appropriate providers.