Here are time frames for determinations on authorization requests for acute inpatient medical admissions

The time frame within which Blue Cross Blue Shield of Michigan and Blue Care Network must make a determination on a request to authorize an acute inpatient medical admission depends on the type of request.

We’ve updated the document Submitting acute inpatient authorization requests: Frequently asked question for providers to include information on the time frames for determinations. You can access that document on these webpages:

• Blue Cross Authorization Requirements & Criteria
• BCN Authorization Requirements & Criteria

For easy reference, we also included the details in the table below. This information applies only to acute inpatient medical admissions, not to behavioral health inpatient admissions.

Here’s more information about the types of requests:

• Standard: Request to reimburse for services.
• Expedited: Request when standard time frame could seriously jeopardize the life or health of a member or the member’s ability to regain maximum function. Requires that a physician attest to the need for an expedited request.
• Preservice: Request is received prior to receipt of care.
• Concurrent: Request is received while member is receiving care.
• Postservice: Request is received after member has been discharged.

Reminders:

• We don’t use the Centers for Medicare & Medicaid Services two-midnight rule; we require authorization for all hospital admissions, both Medicare Advantage and commercial.
• Our authorization program is oriented toward providers, not members. We don’t deny care, services or treatment. Our program determines the appropriate level of care for reimbursement (observation versus inpatient).