While You Are in the Hospital. Once the Plan is notified of your admission, we will review the submitted clinical information to determine if the Inpatient Stay is medically necessary. When an admission is determined to be medically necessary, we notify the facility of Inpatient Stay approval denoting the level of care, approved days and the projected discharge date. If the initial Inpatient Stay is not approved, we will notify your Provider or the Utilization Review team at the hospital and we will explain the reason(s) behind our decision.
Appears in 2 contracts
While You Are in the Hospital. Once the Plan is notified of your admission, we will review the submitted clinical information to determine if the Inpatient Stay is medically necessary. When an admission is determined to be medically necessary, we notify the facility of Inpatient Stay approval denoting the level of care, approved days days, and the projected discharge date. If the initial Inpatient Stay is not approved, we will notify your Provider or the Utilization Review team at the hospital Hospital who is acting as the Member’s representative during their Inpatient stay, and we will explain the reason(s) behind our decision.
Appears in 2 contracts
While You Are in the Hospital. Once the Plan is notified of your admission, we will review the submitted clinical information to determine if the Inpatient Stay is medically necessary. When an admission is determined to be medically necessary, we notify the facility of Inpatient Stay approval denoting the level of care, approved days and the projected discharge date. If the initial Inpatient Stay is not approved, we will notify your Provider or the Utilization Review team at the hospital and we will explain the reason(s) behind our decision.who is
Appears in 2 contracts
While You Are in the Hospital. Once the Plan is notified of your admission, we will review the submitted clinical information to determine if the Inpatient Stay is medically necessary. When an admission is determined to be medically necessary, we notify the facility of Inpatient Stay approval denoting the level of care, approved days and the projected discharge date. If the initial Inpatient Stay is not approved, we will notify your Provider or the Utilization Review team at the hospital and we will explain the reason(s) behind our decisiondecision .
Appears in 1 contract
Samples: Member Benefit Agreement
While You Are in the Hospital. Once the Plan is notified of your admission, we will review the submitted clinical information to determine if the Inpatient Stay is medically necessary. When an admission is determined to be medically necessary, we notify the facility of Inpatient Stay approval denoting the level of care, approved days days, and the projected discharge date. If the initial Inpatient Stay is not approved, we will notify your Provider or the Utilization Review team at the hospital who is acting as the Member’s representative during their inpatient stay, and we will explain the reason(s) behind our decision.
Appears in 1 contract
Samples: Member Benefit Agreement
While You Are in the Hospital. Once the Plan is notified of your admission, we will review the submitted clinical information to determine if the Inpatient Stay is medically necessary. When an admission is determined to be medically necessary, we notify the facility of Inpatient Stay approval denoting the level of care, approved days and the projected discharge date. If the initial Inpatient Stay is not approved, we will notify your Provider or the Utilization Review team at the hospital who is acting as the Member’s representative during their inpatient stay and we will explain the reason(s) behind our decision.
Appears in 1 contract
Samples: Member Benefit Agreement