GHP Family Provider Manual - Geisinger Health Plan

ooooAdmission date (not to exceed 30 days from the date of request)Diagnosis and associated diagnosis codesProcedure and associated procedure codesAny additional/supportive informationConcurrent ReviewParticipating Providers are required to initiate Concurrent Review with the Medical Management Department withinone (1) Business Day of any inpatient admission (planned or unplanned). This information can be submitted via fax to(570) 271-5534 or by emailing the information to GHP_MM_AUTH@thehealthplan.com. Each inpatient admission issubject to the Concurrent Review process, including instances where a case rate/MS-DRG may apply.During Concurrent Review, a determination of continued coverage and a subsequent assigned Concurrent Review datewill be provided by the Medical Management Department staff.• Information required from hospital providers to conduct Concurrent Review:o Date and timeo Authorization numbero Member name, date of birth, and ID numbero Admitting facility and admitting Physiciano Date of admission and admission diagnosiso Reviewer’s name and contact informationo Abnormal vital signso Abnormal lab results including cultureso Imaging results including CXR, CT, MRI/MRAo Current Orders/Plans/Managemento Any unplanned surgeries, complications, etco Anticipated length of stayo Discharge plans/needso Needed outpatient referralsNewborn Notification• Information required from hospital providers to give notice of new births:o Mother’s information:• Mother’s name, Member ID number, date of birth and contact information• Facility name• Reviewer’s name and contact information• Date of admission• Date of Discharge• Diagnosis (vaginal or c-section delivery)• Attending physiciano Baby’s information:• Mother’s name and Member ID number• Baby’s name, sex, and date of birth• Baby’s weight and Apgar score• Discharge/NICU/Detained• Attending physician• Baby’s primary care physician (if known)32