It is important that you continue to consult and comply with all other protocols provided in the Administrative Guide.
- Physicians, health care professionals and ancillary providers are responsible for providing Advance Notification should be submitted as far in advance as possible, but is required to be submitted at least 5 business days prior to the planned service date (unless otherwise specified with the Advance Notification List) with supporting clinical documentation, to allow enough time for coverage review. Advance Notification for home health services and durable medical equipment is required within 48 hours after the start of service. Submitting Advance Notification as early as possible is best.
- It may take up to 15 calendar days to render a decision (14 calendar days for Medicare Advantage). Prioritization of case review is based on the specifics of the case, the completeness of the information received, CMS requirements, or other state or federal requirements. Time may be extended if additional information is needed
- Acute Care Hospitals, Skilled Nursing Facilities and Acute Rehabilitation Facilities are responsible for Admission Notification for inpatient services even if the coverage approval is on file. Notification of each inpatient admission must be received within 24 hours after actual weekday admissions (or by 5:00 p.m. local time on the next business day if 24 hour notification would require notification on a weekend or federal holiday). For weekend and federal holiday admissions, notification must be received by 5:00 p.m. local time on the next business day.
- For information on submitting Admission Notifications electronically, please visit our Electronic Admission Notifications (278N) page
Notes: Failure to comply with the requirements described in greater detail below may result in claims being denied in whole or in part and, as required under your agreement with us, the Customer being held harmless.
For information regarding the following services visit the: Radiology, Cardiology, Oncology pages.