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Notice on Short IP Hospital Stay Policy

Date: 06/07/24

Important Notice on Short Inpatient Hospital Stay Policy

The Centene Short Inpatient Hospital Stay Policy CP.MP.182 addresses medical necessity criteria for day one and day two of an inpatient hospital stay, excluding behavioral health and obstetrical delivery admissions.  As indicated in the policy, observation care is a well-defined set of specific, clinically appropriate services, which include ongoing short-term treatment, assessment, and reassessment prior to deciding whether the patient will require further treatment at an inpatient level of care. 


Inpatient claims denied under this policy are deemed to meet observation level of care based on the criteria presented at the time of admission. If you agree with this determination, a corrected claim can be submitted for observation level of care with the appropriate revenue code and HCPCS combination.


If you are not in agreement with this determination, refer to our provider manuals for information on how to file a reconsideration, appeal or dispute. Provider Manuals are available on our website and can be referenced for additional details.

Peer-to-Peer Process

As a reminder, providers may request a peer-to-peer review of any inpatient admission denied under the Short Inpatient Hospital Stay Policy when prior authorization is requested and the member is in the facility. This allows a concurrent review of the inpatient admit and all applicable criteria, prior to submission of the claim. A peer-to-peer review can be requested by calling the number on your decision notice:

Resources

AzCH providers and staff:

If you have questions, please contact your AzCH Provider Engagement Specialist. If you need your assigned Provider Engagement Specialist’s contact information, please email us at AzCHProviderEngagement@azcompletehealth.com.