[
Approvals for inpatient elective admissions are based on procedures that
require an inpatient level of care. There are times when procedures are
precertified but never performed due to various reasons. In such cases,
Independence is responsible for assessing whether the inpatient admission is
still medically appropriate. Therefore, we are required to confirm if the
precertified procedures were actually performed, and if not, to validate the
medical necessity of the admission.
If we are unable to confirm the procedures, the original authorization
request will remain open and payment will not be made. The Hospital Manual
for Participating Hospitals, Ancillary Facilities, and Ancillary Providers,
which is available in the Current Publications section of Independence
NaviNet® Plan Central, is being updated to reflect this
process.
NaviNet is a registered trademark of NaviNet, Inc., an
independent company.
]