Admission Notification

Acute care hospital

Inpatient admission notification is required for all acute care hospital admissions and discharges within 24 hours of admission. You can notify us by submitting an admission/concurrent review fax form or through HIE (Health Information Exchange), available to Washington state facilities. The admission also requires medical necessity review. The request for medical necessityreview can be initiated by submitting clinical records using the form.

Free-standing psychiatric hospital

Notification required for admissions and discharges. Include medical records with the fax form for review.

Intermediate levels of care Long-term acute care hospital (LTAC) Inpatient rehabilitation facility/unit (IPR) Skilled nursing facility (SNF) Residential treatment center (RTC)

Prior authorization is required instead of admission notification. To submit your request, you can sign in and use our prior authorization tool or submit an admission/concurrent review fax form. Be sure to submit medical records that support the level of care for the prior authorization request.

Maternity

Admission notification isn’t required for any maternity delivery admissions, regardless of the length of the hospital stay. No correspondence will be generated for maternity-related stays.

NICU (Neonatal Intensive Care Unit)

Notification is not required for babies admitted to a NICU.

Observation status admissions

Notification and prior authorization aren't required for observation stays, even if greater than 23 hours. If the patient's status changes to inpatient, notification review is required, and medical records must be faxed to 888-742-1487within 24 hours of admission.

Prior authorization for planned procedures, surgeries

All planned procedures, surgeries, and other services require prior authorization and/or medical necessity review and admission and discharge notification. View our code list for requirements.

Acute care hospital

Inpatient admission notification is required for all acute care hospital admissions and discharges within 24 hours of admission. Admission requires medical necessity review. The request for medical necessity review can be initiated by submitting clinical records by either:

• Submitting an inpatient notification request through Availity (this provides the fastest response).
• Submitting an admission/concurrent review fax form.
• Using HIE (Health Information Exchange), available to Washington state facilities. Note: You'll need to submit clinical records through Availity.

Free-standing psychiatric hospital

Notification required for admissions and discharges. Include medical records with the fax form for review.

Intermediate levels of care

• Long-term acute care hospital (LTAC)
• Inpatient rehabilitation facility/unit (IPR)
• Skilled nursing facility (SNF)
• Residential treatment center (RTC)

Medical necessity prior aMedical necessity prior authorization is required. The request for prior authorization can be initiated by submitting clinical records by either:

• Submitting an inpatient notification request through Availity (this provides the fastest response).
• Submitting an admission/concurrent review fax form.

Maternity

Admission notification isn’t required for any maternity delivery admissions, regardless of the length of the hospital stay. No correspondence will be generated for maternity-related stays.

NICU (Neonatal Intensive Care Unit)

Notification is not required for babies admitted to a NICU.

Observation status admissions

Admission notification and prior authorization are not required for observation stays, even if greater than 23 hours.
If the patient’s status changes from observation to inpatient, admission notification review is required within 24 hours of admission. The request for medical necessity review can be initiated by either:

• Submitting an inpatient notification request through Availity (this provides the fastest response)
• Submitting an admission/concurrent review fax form.

Prior authorization for planned procedures, surgeries

All planned procedures, surgeries, and other services require prior authorization and/or medical necessity review and inpatient admission and discharge notification. View our code list for requirements.
If your planned procedure requires notification or prior authorization for medical necessity review, it can be initiated by submitting clinical records by either:

• Submitting a request through Availity (this provides the fastest response).
• Submitting an admission/concurrent review fax form.