What is preadmission notification (sometimes referred to as precertification or prenotification) and when is it needed?
Consult your benefit booklet or contact the customer service number on your ID card to determine if you are subject to prenotification or precertification prior to certain medical services. Preadmission notification is the requirement to contact the insurance plan before being admitted to a hospital for inpatient care, or within two business days following an emergency hospital admission. Preadmission notification provides information to help determine if case management would be an appropriate option for the member. Preadmission notification is not required for outpatient treatment or any in-state, in-network inpatient admissions. Preadmission notification is also not required for maternity admissions unless your medical condition requires you to stay more than 48 hours after a vaginal delivery or 96 hours after a cesarean section. If your inpatient admission does not fall within the described exceptions previously mentioned, your policy may require preadmission notification. You, you
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