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PRE-ADMISSION AUTHORIZATION
In cases where a member requires elective or urgent hospital admission, the admitting physician agrees to contact Atlantis Health Plan Utilization Department in advance to secure a pre-certification number for the admission prior to the admission. Additionally, the admitting physician agrees to cooperate and participate in a coordinated discharge planning program.
In the case of an emergency hospital admission, it is the responsibility of the hospital to notify Atlantis Health Plan of the admission. Participating hospitals should notify Atlantis Health Plan Utilization Department within forty-eight (48) hours of the admission. Within twenty-four (24) hours or one (1) business day after Atlantis Health Plan is notified of an Emergency Room admission, Atlantis Health Plan will notify the PCP of record either electronically or by telephone. The participating physician may also wish to notify Atlantis Health Plan of the admission, but this notification is not essential. A Utilization Management Nurse reviews all emergency admissions on the first business day following the admission notification for appropriateness.
For additional information regarding the Atlantis Health Plan pre-authorization/referral policy please refer to the pages 40-43 of this manual.
CONCURRENT REVIEW PROCESS
Concurrent review is the process of determining whether requests for continued or extended services are medically necessary or appropriate at the level of care desired, based on current professionally acceptable care and criteria. This process is integrated with case management activities for clinically complex cases.