New Claims System Update

Provider Manual
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9 Hospital and Elective Admission Management

9.2 Inpatient Admission Reviews

All inpatient hospital admissions, including urgent and emergent admissions, 72 hours from the date and time of receipt of the admission notification. Urgent and emergent admissions require notification within one business day by the provider. The IntegraNet utilization review clinician determines the member’s medical status through communication with the hospital’s Utilization Review department. Appropriateness of the stay is documented, and concurrent review is initiated. Cases may be referred to the Medical Director who renders a decision regarding the coverage of hospitalization.