If a hospital has an inpatient on the transition date, does the MCO need to be contacted for a new authorization to be reimbursed?
No, but notifying the new MCO would be appreciated for coordination and discharge planning purposes. For diagnosis-related grouping (DRG)-based reimbursement, the MCO on the date of admission is responsible for the hospital claim for the entire length of stay. However, per diem and professional services are reimbursed by the plan in effect on the date of service. The provider should contact the MCO for billing questions. Hospital transfers require authorization by the MCO in effect on the date of transfer.
Related Questions
- If a hospital has an inpatient on the transition date, does the MCO need to be contacted for a new authorization to be reimbursed?
- How does NMHPA affect prior authorization or pre-certification for a hospital stay in connection with childbirth?
- What are the benefits for inpatient hospital confinements, maternity or residential treatment care?
