Elective Inpatient Admissions Sample Clauses

Elective Inpatient Admissions. The Covered Person and his/her practitioner determine the Covered Persons care and hospitalization. However, in order to qualify for maximum benefits coverage, prior to the admission the attending practitioner must call COMPARE, using the toll-free number, and provide demographic information, the Covered Person's history and physical findings, drug work up, comprehensive treatment plan, treatment goals, and proposed duration of therapy, as well as information on educational background of the primary and attending practitioner. If the Covered Person is participating in a formal mental health program, the practitioner must also inform the coordinator if the program has been certified by an authorizing organization (e.g., AHA, JCAHA). Failure of the attending physician to provide information as outlined on a timely basis may result in inability to complete review. This information is then reviewed by a COMPARE coordinator. A Mental Health Review (MHR) practitioner contacts the attending physician if the information appears to be incomplete or if it does not appear that the admission can be certified as medically necessary under the terms of the Covered Persons benefit plan. If COMPARE'S coordinator or MHR practitioner determines that the admission can be certified as medically necessary under the terms of the benefit plan, he or she assigns a length of stay to determine the date for the nest review. All recommendations of non-certification and all cases where review is incomplete are verified to the PLANS written copies of which will also be sent to the Covered Person, attending physician, and hospital if appropriate. COMPARE will provide verbal notice of its recommendations to the attending practitioner and will assign a certification number to the certification period.
Sample 1
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Related to Elective Inpatient Admissions

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