Reminder: Effective August 1, 2024: Updated Requirements for Inpatient and Observation Admissions
At CareFirst BlueCross BlueShield (CareFirst) and CareFirst BlueChoice, Inc. (BlueChoice), ensuring our members are consistently receiving the right care at the right time and the right level is our priority. As a reminder, 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 and June BlueLink Newsletters as well as in this Provider News email sent on May 2, 2024.
- Note: A link to the Payment Policy Database is also available on the CareFirst BlueCross BlueShield Community Health Plan Maryland (CareFirst CHPMD) and CareFirst BlueCross BlueShield DualPrime (HMO-SNP) 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 additional information, updates and resources to assist with these requirements.
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 Advantage DualPrime lines of business.
What are the updated requirements?
- 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 an inpatient notification be submitted through the inpatient section of the Prior Authorization/Notification Portal.
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. These notifications should be submitted as they are today.
- 24 Hour Notification Required for Observation Stays
In addition, all observation stays will require 24-hour notification to CareFirst. CareFirst’s preference is that observation notification be submitted through the inpatient section of the Prior Authorization/Notification Portal. Despite this entry point observation stays are still considered outpatient.
Important Information for BlueChoice HMO Members: BlueChoice HMO patients require prior authorization for observation services. These are currently entered as outpatient requests and should continue to be entered this way. This new policy does not impact the way observation authorizations are entered for these members. For more information about how to enter an outpatient authorization, access the Entering Outpatient Authorizations course.
- 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.
Please review the FAQs provided below for more specific information about these requirements.
What training resources are available?
The following information and training are currently available to support providers to support this new policy:
- Resource for All Lines of Business
- Commercial, FEP and Medicare Advantage Members
- CareFirst CHPMD and Advantage DualPrime Members
Where can I find more information?
We will continue to cover this topic during our upcoming live webinars in September. Click on one of the sessions below to register.
Hospital Quarterly Live Webinars
CareFirst CHPMD and Advantage DualPrime Live Webinars