Common use of Inpatient Hospital Pre-Admission Review Clause in Contracts

Inpatient Hospital Pre-Admission Review. When the Member’s Medicare coverage is primary coverage to this CareFirst BlueChoice plan, prior authorization for inpatient hospital services will not be required. Coverage of inpatient hospital services is subject to the requirements for pre-admission review, concurrent review, and discharge planning for all covered hospitalizations. Such review and approval will determine: A. The need for hospitalization; B. The appropriateness of the approved hospital or facility requested; C. The approved length of confinement in accordance with CareFirst BlueChoice established criteria; and D. Additional aspects such as second surgical opinion and/or pre-admission testing requirements. SAMPLE Failure or refusal to comply with notice requirements and other CareFirst BlueChoice authorization and approval procedures may result in reduction of benefits or exclusion of services from coverage.

Inpatient Hospital Pre-Admission Review. When the Member’s Medicare coverage is primary coverage to this CareFirst BlueChoice plan, prior authorization for inpatient hospital services will not be required. Coverage of inpatient hospital services is subject to the requirements for pre-pre- admission review, concurrent review, and discharge planning for all covered hospitalizations. Such review and approval will determine: A. The need for hospitalization; B. The appropriateness of the approved hospital or facility requested; C. The approved length of confinement in accordance with CareFirst BlueChoice established criteria; and D. Additional aspects such as second surgical opinion and/or pre-admission testing requirements. SAMPLE Failure or refusal to comply with notice requirements and other CareFirst BlueChoice authorization and approval procedures may result in reduction of benefits or exclusion of services from coverage.

Inpatient Hospital Pre-Admission Review. When the Member’s Medicare coverage is primary coverage to this CareFirst BlueChoice plan, prior authorization for inpatient hospital services will not be required. Coverage of inpatient hospital services is subject to the requirements for pre-admission review, concurrent review, and discharge planning for all covered hospitalizations. Such review and approval will determine: A. The need for hospitalization; B. The appropriateness of the approved hospital or facility requested;; SAMPLE C. The approved length of confinement in accordance with CareFirst BlueChoice established criteria; and D. Additional aspects such as second surgical opinion and/or pre-admission testing requirements. SAMPLE Failure or refusal to comply with notice requirements and other CareFirst BlueChoice authorization and approval procedures may result in reduction of benefits or exclusion of services from coverage.

Inpatient Hospital Pre-Admission Review. When the Member’s Medicare coverage is primary coverage to this CareFirst BlueChoice plan, prior authorization for inpatient hospital services will not be required. Coverage of inpatient hospital services is subject to the requirements for pre-admission review, concurrent review, and discharge planning for all covered hospitalizations. Such review and approval will determine: A. The need for hospitalization; B. The appropriateness of the approved hospital or facility requested; C. The approved length of confinement in accordance with CareFirst BlueChoice established criteria; and D. Additional aspects such as second surgical opinion and/or pre-admission testing requirements. SAMPLE Failure or refusal to comply with notice requirements and other CareFirst BlueChoice authorization and approval procedures may result in reduction of benefits or exclusion of services from coverage.

Inpatient Hospital Pre-Admission Review. When the Member’s Medicare coverage is primary coverage to this CareFirst BlueChoice plan, prior authorization for inpatient hospital services will not be required. Coverage of inpatient hospital services is subject to the requirements for pre-admission review, concurrent review, and discharge planning for all covered hospitalizations. Such review and approval will determine: A. The need for hospitalization; B. The appropriateness of the approved hospital or facility requested; C. The approved length of confinement in accordance with CareFirst BlueChoice established criteria; andand Sample D. Additional aspects such as second surgical opinion and/or pre-admission testing requirements. SAMPLE Failure or refusal to comply with notice requirements and other CareFirst BlueChoice authorization and approval procedures may result in reduction of benefits or exclusion of services from coverage.