Effective Jan. 11, 2021, all acute inpatient hospitalizations require notification to the plan (Samaritan Health Plans/InterCommunity Health Network CCO) within the following parameters to ensure appropriate coordination of care for members:
- Notifications must be submitted via fax within 24 hours of admission, or next business day for weekend or holiday admissions.
- Observation stay notifications should be sent as soon as stay exceeds 48 hours or within 24 hours of the inpatient order.
- All inpatient stay notifications are subject to medical necessity review.
- Clinical information must be received within 48 hours following the request.
Notifications should include the following:
- Member demographic information.
- Member date of birth.
- Member ID.
- ICD-10 codes.
Incomplete notifications or late notifications may cause a delay in coordination of care and result in an administrative denial of care provided prior to the date in which the notification is received.