Clarifying Guidance: Elective Medical Inpatient Authorization Process Change Effective May 1st, 2024

Date: 03/27/24

This bulletin is intended to clarify guidance previously shared on March 1st regarding a process change for inpatient authorizations. 

Providers should continue to request an authorization for elective inpatient services at least (5) days before the scheduled service delivery date. The only change to the provider is within the authorization number provided; it will begin with prefix "OP" (outpatient). 

Upon the patient admitting for the inpatient stay following the procedure, please notify Ambetter of North Carolina Inc. within one business day in the same manner you do today.

You do not have to request a second inpatient authorization for the stay. Once you notify the health plan of admission, the authorization  already on file will transition into the IP authorization with a new auth number provided. 

If you have questions regarding the information contained in this update, please contact your Provider Engagement Administrator. If you need your assigned Provider Engagement Administrator contact information, please visit: network.carolinacompletehealth.com/engagement