Hospital providers should request an administrative level of care authorization under the following circumstances:
- A member no longer requires acute inpatient care but remains in an acute inpatient hospital bed because a suitable accepting provider has not yet been found to meet the member’s medical needs.
Exclusions
Requests for administrative level of care authorization are not applicable in the following situations:
- Dates of service being requested have been approved for acute inpatient level of care
- Lack of timely discharge planning
- No documentation of placement efforts
- Social or family issues that delay or prevent placement
- Patient accepted to a nursing facility, but placement or transfer is delayed due to awaiting legal conservatorship
Placement requests that do not qualify include:
- Congregate Living Health Facility
- Homeless shelter/recuperative care
- Respite care center
- Board and care facility
Steps for Submission
To ensure smooth processing and avoid unnecessary delays, please complete the following steps for submission:
1. Form Completion
Use the "Hospital Review Priority Type of Clinical Service Requested" form.
2. Administrative Days Request
Clearly mark the request as "Administrative Days Request."
3. Reference Number
Include the Acute Inpatient Reference Number or Document ID number.
4. Specify Dates of Service
Provide the exact dates of service for which administrative days are requested.
5. Supporting Documentation
Attach clinical records that demonstrate the medical necessity for the requested administrative days.
Need Assistance?
If you have questions or need further clarification, please reach out as follows:
- Account Manager - For inquiries, please contact your Account Manager.
- Utilization Management Call Center - Call our Utilization Management Call Center at 877-431-2273, and select option 3, followed by option 2.
Following these guidelines will help ensure a streamlined process for administrative level of care authorization requests.