Effective August 1, 2024: Updated Requirements for All Inpatient and Observation Admissions
At CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. (CareFirst), ensuring our members are consistently receiving the right care at the right time and the right level is our priority. Effective August 1, 2024, there will be updated requirements for inpatient and observations admissions. These requirements are included in the Inpatient and Observation Care Notification Requirements Policy announced in the April BlueLink Newsletter.
- Note: A link to the Payment Policy Database will also be available on the CareFirst CHPMD and CareFirst BlueCross Blue Shield Dual Prime provider websites. Currently the Hospital Inpatient and Observation Admissions Payment Policy is the only policy in the database that impacts these lines of business.
The purpose of this communication is to provide an overview of the requirements along with opportunities to learn more detailed information through our live webinar opportunities, FAQs and training resources that will soon be available.
Which members will these changes impact?
The requirements outlined below apply to all CareFirst members. This includes members covered under Commercial, Federal Employee Program (FEP), Medicare Advantage, CareFirst CHPMD (Medicaid), and CareFirst BlueCross BlueShield DualPrime (Medicare DSNP) lines of business.
What are the updated requirements?
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24 Hour Notification Required for Inpatient Admissions
Beginning August 1, 2024, CareFirst requires all Facilities to provide notification of an inpatient admission within 24 hours of admission. CareFirst’s preference is that notification be submitted as an inpatient request.
EXCEPTION: CareFirst’s Maryland Medicaid Managed Care Organization, CareFirst Community Partners, Inc., requires all Facilities to provide notification of an inpatient admission or observation stay that exceeds 24 hours. Such notification must be provided within 48 hours of the admission, or by the next business day for weekend and holiday admissions.
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24 Hour Notification Required for Observation Stays
In addition, all observation stays will require 24-hour notification to CareFirst. These notifications should be submitted to CareFirst as an inpatient request.
Important Note for BlueChoice Members: BlueChoice patients already require notification for observation services. These are currently entered as outpatient requests. Beginning August 1, 2024, an inpatient request for admission to observation level of care will need to be submitted instead.
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Level of Care Required on Inpatient Requests
Level of care will need to be indicated on all inpatient requests as well beginning August 1, 2024. To indicate the level of care information, providers will be asked to include the appropriate revenue code as part of the request.
Where can I find more information?
Additional information and training will be provided as we get closer to implementation. We will also be covering this topic in detail during our upcoming live webinars in May. Click on one of the sessions below to register.
Hospital Quarterly Live Webinars
CHPMD and DSNP Live Webinars
Will training resources be available?
Yes, please be on the lookout for additional communication and FAQs about these requirements along with training resources that will be included on our Learning and Engagement Center as we get closer to August 1, 2024.