Notification of Hospital Admissions

Hospitals are required to report any Health Net member's including Individual Family Plan (IFP) Ambetter HMO and Ambetter PPO members inpatient admissions within 24 hours or one business day when an admission occurs on a weekend, seven days a week to the Hospital Notification Unit. Failure to notify according to the requirements in the Provider Participation Agreement (PPA) may result in a denial of payment.

On receipt of admission notification, Health Net creates a tracking number and provides it to the reporting party. The tracking number is not, by itself, an authorization that services are covered under a member's benefit plan. Any services authorized by Health Net at the time of notification or thereafter are noted in the Health Net notification system. The tracking number is also transferred electronically to the Health Net claims processing system. To report a Health Net member inpatient admission, contact the Health Net Hospital Notification Unit.

Notification of after-hours admissions may be made by telephone (the information is recorded by voicemail) or by fax. On the next business day, a Health Net representative verifies eligibility, obtains information regarding the admission and, if applicable, provides a tracking number for the case.

When reporting inpatient admissions, the following information must be provided:

• Member name.
• Subscriber identification (ID) number.
• Attending and admitting physicians' first name, last name and contact information.
• Admission date and time of admission.
• Admission type (such as emergency room, elective or urgent).
• Facility name and contact information.
• Level of care.
• Admitting diagnosis code.
• CPT procedure code, if available.
• Facility medical record number.
• Participating physician group (PPG) authorization number (if applicable).
• For obstetrical (OB) delivery admissions, include newborn sex, weight, apgar score, time of birth, and medical record number.
• Discharge date, if applicable.
• Other insurance information, if applicable.

Timely notification of Health Net member inpatient admissions assists with timely payment of claims, reduces retroactive admission reviews and enables Health Net to concurrently monitor member progress. Health Net requires hospitals to notify the Hospital Notification Unit and the PPG (if applicable) or provider of a member's inpatient admission within 24 hours or one business day when an admission occurs on a weekend for the following services:

• All inpatient hospitalizations.
• Skilled nursing facility (SNF) admissions.
• Inpatient rehabilitation admissions.
• Inpatient hospice services.
• Emergency room admissions.

Requests for Authorization for Post-Stabilization Care at Non-Participating Hospitals

Notify the Hospital Notification Unit immediately if a non-participating hospital requests an authorization for post-stabilization care for a member who is in the emergency room or an inpatient admission. After-hours admissions for non-participating facilities reporting a post-stabilization case are answered 24 hours a day, seven days a week by following telephone prompts routed to the State Health Programs call center. Refer to the Non-Participating Hospital Request for Authorization to Provide Post-Stabilization Services section.