Ambetter: Prior Authorization changes effective through 03/01/2022

Date: 02/02/22

To support the Ambetter membership and Ambetter Provider Network, the following changes will be effective through March 1, 2022

Inpatient Admissions:  Ambetter will allow notification of admission up to 5 days post admission date and complete medical necessity reviews when notification is received.

Post-Acute Accommodations for rehab hospitals and Long Term Acute Care hospitals (LTACH):

Ambetter will relax our requirements related to facility transfers including:

• Ambetter will not require discharging acute care facilities to obtain prior authorization for patient transfers to participating post-acute facilities. 
• Ambetter will not require sending facilities to provide notification of transfer to participating providers. 
• However, Ambetter will require receiving facilities to notify the health plan of patient admission.  Ambetter will accept notification up to five days post-transfer.
• Ambetter will continue to conduct medical necessity review
• Because Ambetter will not have visibility prior to transfer, Ambetter request that hospitals utilize our in network post-acute facilities

Skilled Nursing Facilities: Ambetter will allow post admission notification and authorize up to a 7 day stay before medical necessity continued stay review.