FLASH: Extension of Inpatient Authorization for Select Outpatient Procedures Performed Within Seven Days of Discharge

Health Alliance^TM and Health Alliance Northwest^TM Ease Utilization Management Requirements for Providers

We have heard you and know how busy you are. We have brainstormed new and unique ways to ease the burden for you and your staff. In an effort to both provide additional support to you and improve patient access, we’re creating a new post-discharge extension of the Inpatient Authorization to select Outpatient procedures that are performed within seven days of the Inpatient discharge. 

Beginning September 15th, 2021, Health Alliance and Health Alliance Northwest:

• Procedures performed in an Inpatient setting are covered under the Inpatient authorization. We will extend this (Inpatient) Authorization on select Outpatient procedures for patients who have been discharged from an Inpatient stay, if the Outpatient procedure is performed within seven days of their discharge date.

The goal of this extension is to assist in expediting the discharge of patients requiring procedures that can be done in an Outpatient setting.  Procedures included were based on volume and approval rate. The list includes 70% of the imaging and lab procedures that require prior authorization. In-scope codes can be found in the table below.

• Procedures on the list performed beyond the seven-day post-discharge window will still require the usual prior authorization.
• Codes that are not on the list and require prior authorization will continue to require the usual prior authorization within the seven-day window.
• We expect provider systems to track and coordinate care for these patients to make sure they receive the necessary procedure post discharge.

Seven-Day Post-Discharge Authorization Extension List, Effective 9/15/21*

*Extension list is CPT code specific.

Thanks for all that you do to take care of our members’ health. We’re proud to offer this flexibility to help you and your staff, and we’ll continue to look for more ways we can improve patient access, expedite discharge planning and alleviate administrative burden.
 
Chester Ho, MD – SVP & Chief Medical Officer   

April Vogelsang, RN, MS –  SVP & Chief Clinical Integration Officer