Elective Medical Inpatient Authorization Process Change

Date: 01/22/24

Ambetter from Peach State Health Plan will introduce a change to the Elective Medical Inpatient Authorization Process to provide increased flexibility and to better align with industry best practices. Effective April 1, 2024, we are making the following changes to our elective medical inpatient authorization process.

1. Prior authorizations for elective inpatient services will be approved for professional services by issuing an outpatient (OP) authorization.
   1. Elective Inpatient Prior Authorization numbers will now start with the prefix of OP instead of IP (i.e., OP123456789).
   2. The authorization will indicate approval at the inpatient level of care.
2. The prior authorization span for elective inpatient admissions will be increased to 90 days for dates of service on or after April 1, 2024. 
3. If the planned admission date exceeds the authorized date span of 90 days, a new authorization span is required.
4. (IP authorization) will be built and processed at the time of admission.
   1. Services can be rendered any time within the authorization time span. 
   2. Notification of admission is required within one business day of admit. At the time of admission notification, a new authorization number for the admission will be provided with the IP prefix (IP Authorization).
5.  Failure to provide timely notification may result in a denial of payment for the submitting facility. 

As a reminder, all planned/elective admissions to the inpatient setting require prior authorization. Prior authorization should be requested at least five (5) days before the scheduled service delivery date or as soon as need for service is identified. If prior authorization is not on file at the time of elective admission, the service is considered retrospective, and provider should follow the appropriate retrospective request process. Emergent admissions do not require prior authorization.

Thank you for continuing to provide our members with high quality and compassionate care. If you have questions regarding the information contained in this update, please reach out to Provider Services at 1-877-687-1180.