Enhancements to hospital prenotification system to be implemented in August 2013

In response to customer requests, Blue Cross Blue Shield of Michigan is enhancing its hospital prenotification system to capture data that will better support inpatient admissions. The changes will be implemented in August 2013.

They include the following:

• BCBSM will require all hospitals to reference InterQual^® criteria for inpatient admissions and indicate which subset was referenced and met. If a doctor is overriding InterQual inpatient criteria, then the hospital must provide the doctor’s name and phone number.
• Hospitals will be encouraged to enter symptoms exhibited at admittance and the necessary treatment.
• We will require hospitals to reference the Centers for Medicare & Medicaid Services inpatient surgical list for all Medicare Advantage PPO inpatient surgical procedures. If a physician is overriding the CMS inpatient surgical list, then the hospital must provide the physician’s name and phone number.
• Hospitals will be required to provide an ICD-9-CM narrative for admissions. We ask that hospitals also enter the ICD-9-CM diagnosis code that corresponds with the narrative.

We’ll provide additional details, including training opportunities, in a future issue of The Record.