Pre-certification of Hospital Admission & Length of Stay Sample Clauses

Pre-certification of Hospital Admission & Length of Stay. The pre- 24 certification for admission and length of stay component of the plan 25 requires that the attending physician submit to the third party administrator 26 (TPA) the diagnosis, plan of treatment and expected duration of 27 admission. If the admission is not an emergency, the submission must be 28 made by the attending physician and the review and approval granted by 29 the TPA prior to admitting the covered individual into the acute care
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Pre-certification of Hospital Admission & Length of Stay. The pre-certification for 15 admission and length of stay component of the plan requires that the attending 17 treatment and expected duration of admission. If the admission is not an 18 emergency, the submission must be made by the attending physician and the 20 into the acute care facility. If the admission occurs as an emergency, the 21 attending physician is required to notify the TPA by telephone with the same 22 information on the next regular working day after the admission occurs. If the 23 admission is for a maternity delivery, advance approval for admission will not be 24 required; however, the admitting physician must notify the TPA before the 25 expected admission date to obtain the length-of-stay approval. There will be no 26 limitation on benefits caused by the attending physician’s failure to obtain pre- 27 admission certification.
Sample 1Sample 2
Pre-certification of Hospital Admission & Length of Stay. The pre-certification for admission and length of stay component of the plan requires that the attending physician submit to the third party administrator (TPA) the diagnosis, plan of treatment and expected duration of admission. If the admission is not an emergency, the submission must be made by the attending physician and the review and approval granted by the TPA prior to admitting the covered individual into the acute care facility. If the admission occurs as an emergency, the attending physician is required to notify the TPA by telephone with the same information on the next regular working day after the admission occurs. If the admission is for a maternity delivery, advance approval for admission will not be required; however, the admitting physician must notify the TPA before the expected admission date to obtain the length-of-stay approval. There will be no limitation on benefits caused by the attending physician’s failure to obtain pre- admission certification.
Sample 1
Pre-certification of Hospital Admission & Length of Stay. The pre-certification 9 for admission and length of stay component of the plan requires that the 10 attending physician submit to the third party administrator (TPA) the 11 diagnosis, plan of treatment and expected duration of admission. If the 12 admission is not an emergency, the submission must be made by the 13 attending physician and the review and approval granted by the TPA prior to 14 admitting the covered individual into the acute care facility. If the admission 15 occurs as an emergency, the attending physician is required to notify the TPA 16 by telephone with the same information on the next regular working day after 17 the admission occurs. If the admission is for a maternity delivery, advance 18 approval for admission will not be required; however, the admitting physician 19 must notify the TPA before the expected admission date to obtain the length- 20 of-stay approval. There will be no limitation on benefits caused by the 21 attending physician’s failure to obtain pre-admission certification. 22
Sample 1

Related to Pre-certification of Hospital Admission & Length of Stay

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