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Inpatient Admissions

Providers will need to answer the following questions on GuidingCare in order to request a pre-authorization for Inpatient Admissions. If you are not a UM manager, please enter as much information as you can and have the UM department update the rest.

Screen One: First Section of Guiding Care

  1. Who is the provider requesting pre-authorization?
    All Provider fields: Enter Facility name.
  2. 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.
  3. Who is the patient requiring the pre-authorization?
    First try entering member’s ID number than try patient’s name. Can see if member remains eligible for CCHP when you choose correct member.
  4. What is the patient’s diagnosis?
    ICD 10 code.
  5. What is the procedure code?
    Enter an appropriate REV code for inpatient admission, Ex: 0120 for Medical or 0124 Psychiatric.
  6. 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.
  7. Are there any other details?
  8. 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 file-
    copy of orders
    pertinent medical information
    MD progress notes
    copies of imaging results
    Any records that will help us determine

MAKE SURE TO SUBMIT REQUEST

  • Submit with the Blue submit button and the MCG Guideline Orange submit button.
  • Without submitting the request, CCHP will not be able to see the authorization.

Please check your messages to get the information from the UM nurse that is reviewing this episode and they will provide you with their name and phone number and if there is further clinical documentation that is needed that will ask for that here. This is also where you will be informed of the status of the episode.