Inpatient Admissions
Inpatient Admissions
The inpatient admissions process helps to balance quality care and the use of quality resources. Timely notifications and clinical documentation allow CCHP to confirm the appropriateness of hospital stays, manage length of stay, and coordinate discharge planning. This process helps control costs, prevent fraud and abuse, and support continuity of care through case management.
Providers will need to follow this process and answer the following questions in the GuidingCare Auth Portal to request a pre-authorization for Inpatient Admissions.
If you are not a UM manager, please enter as much information as you have available then have your UM department provide updates to the remainder of the information.
Screen One
First Section in GuidingCare
Who is the provider requesting pre-authorization?
All Provider fields: Enter Facility name.
What is the Request Type?
Inpatient Acute Hospitalization/Inpatient Acute Psychiatric/Inpatient Maternity. If pregnant woman is admitted for other than a delivery please pick Inpatient Acute Hospitalization.
Who is the patient requiring the pre-authorization?
First enter the member ID number, if no results, enter the patient’s name. Choose the correct member and then you will see if the member selected remains eligible for CCHP.
What is the patient’s diagnosis?
ICD 10 code.
What is the procedure code?
Enter an appropriate REV code for inpatient admission, Ex: 0120 for Medical or 0124 Psychiatric.
At which facility does the service need to be performed? (Where are you located at?)
Hospital’s Name.
Start Date of Care : include admission date.
Requested Level of Care: Inpatient.
Are there any other details?
Include any additional information.
Please provide the following additional information (Who will the nurses contact?)
Contact Name - UM.
Name Contact - UM Phone Number.
Contact - UM Fax Number.
Screen Two
Authorization Request Review Screen
Each Code will have “Document “, click to open.
Include note for attached clinical or no clinical available.
Attach the following files:
- Copy of orders
- Pertinent medical information
- MD progress notes
- Copies of imaging results
- Any records that will help us determine
Please check your messages. The UM nurse reviewing the episode will leave a message with pertinent information. You will receive contact information, a name and phone number, and details around any further clinical documentation that is needed. The UM nurse will also provide a status of the episode.