19-075 Inpatient Notification Requirement

Date: 02/07/19

Timely notification helps ensure prompt claims payments and reduced retroactive admission reviews 

The information in this update applies to all California Health & Wellness Plan (CHWP) member admissions to an inpatient care setting, acute rehabilitation, hospice, long-term acute care, and skilled nursing facilities.

In accordance with the Provider Participation Agreement (PPA), CHWP requires notification of the  member’s inpatient admission within 24 hours or the next business day when an admission occurs on the weekend. Timely notification of admissions assists with timely payment of claims, reduces retroactive admission reviews and enables CHWP to concurrently monitor member progress.

SERVICES REQUIRING NOTIFICATION

CHWP and the member’s independent practice association (IPA) require notification within 24 hours or the next business day when an admission occurs on the weekend for:  

• All inpatient hospitalizations.
• Inpatient acute care rehabilitation admissions.      
• Long-term acute care (LTAC) admissions.
• Skilled nursing facility (SNF) admissions.
• All SNF to acute transfers; bed holds and return from bed holds.   
• SNF leave of absence (LOA).

REQUIRED INFORMATION

When reporting inpatient admissions, acute transfers, bed holds, and LOAs to CHWP and the IPA, include the following:

• Member name.
• Subscriber identification (ID) number.
• Attending and admitting physicians’ first and last names.
• SNF name and address.
• Admission date and time.
• Admission type (for example, acute care inpatient, SNF, acute rehabilitation unit (ARU), LTAC, elective, or urgent).
• Inpatient facility name and address.
• Level of care.
• Admitting diagnosis and code.
• CPT procedure code, if applicable.
• Facility medical record number.
• PPG authorization number.
• Discharge date, if applicable.

NOTIFICATION PROCESS

Inpatient admissions must be faxed to the Hospital Notification Unit (HNU) fax line at 1-855-556-7907, 24 hours a day, seven days a week. A fax cover sheet must accompany all fax transmissions of Protected Health Information. The cover sheet must be labeled “PROTECTED HEALTH INFORMATION.” If urgent notification is needed, contact HNU by telephone at 1-877-658-0305, Monday through Friday, 8:00 a.m. to 5:00 p.m. Pacific time.

TRACKING

For fax notifications, inpatient services are entered into the CHWP notification system and, if applicable, a tracking number is created within 24 hours of receipt of the fax. Fax notifications received after 5:00 p.m. are entered the following business day.

ADDITIONAL INFORMATION

Relevant sections of the provider operations manuals have been revised to reflect the information contained in this update as applicable. The provider operations manual is available in the Provider Resources section of the provider website at www.CAHealthWellness.com.

Providers are encouraged to access CHWP’s provider portal online at www.CAHealthWellness.com for real-time information, including eligibility verification, claims status, prior authorization status, plan summaries, and more.

If you have questions regarding the information contained in this update, contact CHWP at 1-877-658-0305.