Retrospective Inpatient Hospital Reviews. The Contractor shall have the capability and established procedures to receive Retrospective review request for Inpatient and Outpatient services within sixty (60) days of the service date and conduct prepayment reviews. The Contractor shall ensure determinations for Retrospective Reviews are completed ninety-eight percent (98%) of the time within twenty (20) business days of receipt. The Contractor shall develop and maintain a Web-based, electronic review request system for Prior Authorization and prepayment review of inpatient medical/surgical/behavioral health services that allows for data input by the submitting providers. The Contractor’s system shall have the capability for automated criteria/rules-based certification system. The Contractor shall manually review each Prior Authorization and prepayment review request received that is not certified by the Contractor’s rules- based system, along with any required supporting documentation to support the need for inpatient medical/surgical services.
Appears in 5 contracts
Samples: medicaid.ms.gov, medicaid.ms.gov, medicaid.ms.gov
Retrospective Inpatient Hospital Reviews. The Contractor shall have the capability and established procedures to receive Retrospective review request for Inpatient and Outpatient services within sixty (60) days of the service date and conduct prepayment reviews. The Contractor shall ensure determinations for Retrospective Reviews are completed ninety-eight percent (98%) of the time within twenty (20) business days of receipt. The Contractor shall develop and maintain a Web-based, electronic review request system for Prior Authorization and prepayment review of inpatient medical/surgical/behavioral health surgical services that allows for data input by the submitting providers. The Contractor’s system shall have the capability for automated criteria/rules-based certification system. The Contractor shall manually review each Prior Authorization and prepayment review request received that is not certified by the Contractor’s rules- based system, along with any required supporting documentation to support the need for inpatient medical/surgical services.
Appears in 4 contracts
Samples: medicaid.ms.gov, medicaid.ms.gov, medicaid.ms.gov
Retrospective Inpatient Hospital Reviews. The Contractor shall have the capability and established procedures to receive Retrospective review request for Inpatient and Outpatient services within sixty (60) days of the service date Hospital Review requests and conduct prepayment reviewsreviews as such conditions are identified. The Contractor shall ensure determinations for Retrospective Inpatient Hospital Reviews are completed ninety-eight percent (98%) of the time within twenty (20) business days of receipt. The Contractor shall develop and maintain a Web-based, electronic review request system for Prior Authorization and prepayment review of inpatient medical/surgical/behavioral health surgical services that allows for data input by the submitting providers. The Contractor’s system shall have the capability for automated criteria/rules-based certification system. The Contractor shall manually review each Prior Authorization and prepayment review request received that is not certified by the Contractor’s rules- based system, along with any required supporting documentation to support the need for inpatient medical/surgical services.
Appears in 1 contract
Samples: www.medicaid.ms.gov
