Hospitals must notify LifeWise of all inpatient admissions and discharges. Most plans require prior authorization.
How to submit your admission notification
For admissions or facilities that require a notification, you can notify us by signing in and using our prior authorization tool or submitting an
admission/concurrent review fax form.
For more information, call 800-596-3382, option 3.
|Type of admission or facility
||What’s required, what you need to know
|Acute care hospital
||Inpatient notification is required for all acute care hospital admissions and discharges within 24 hours of admission. You can notify us by submitting an admission/concurrent review fax form. The admission also requires medical necessity review. The request for medical necessity review can be initiated by submitting clinical records using the form.
|Free-standing psychiatric hospital
||Notification required for admissions and discharges. Include medical records with the admission/concurrent review fax form for review.
|Intermediate levels of care
For skilled nursing facilities:
Prior authorization requirements
temporarily waived for SNF transfers
Due to the increase in COVID-19 related admissions, we’re temporarily waiving
the prior authorization requirement for skilled nursing facilities (SNFs) effective September 7, 2021, through January 16,
2022. For documentation, please provide admission notification
and discharge date via fax at 888-742-1487. Refer Premera members to a
contracted facility when possible to reduce member cost share. To find a list
of contracted SNFs, use our provider directory and search for skilled nursing.
This is not a guarantee of payment.
Claims for this admission will be paid based on benefits and eligibility in
effect at the time of service. Sign in to the provider portal to review member
benefit limits. Premera reserves the right to perform a retrospective review of
services if claims or payment discrepancies arise.
For long-term acute care hospital(LTAC), inpatient rehabilitation facility/unit (IPR), residential treatment center (RTC)
Prior authorization is required instead of admission notification. You can notify us by signing in and using our prior authorization tool or submitting an admission/concurrent review fax form.
Be sure to submit medical records that support the level of care for the prior authorization request.
||Notification isn’t required for first 48 hours for vaginal delivery and first 96 hours for Cesarean delivery. Notification is required for anything beyond these time frames. You can notify us by signing in and using our prior authorization tool or submitting an admission/concurrent review fax form.
|NICU (Neonatal Intensive Care Unit)
||Inpatient admission notification is not required for babies admitted to a NICU.
|Observation status admissions
||Notification and prior authorization aren’t required for observation stays, even if greater than 23 hours. If the patient’s status changes to inpatient, notification review is required, and medical records must be faxed to 888-742-1487 within 24 hours of admission.
|Prior authorization for planned procedures, surgeries
||All planned procedures, surgeries, and other services require prior authorization and/or medical necessity review and admission and discharge notification. View our code list for requirements.