In an effort to help facilities accept patients during the COVID-19 pandemic, QualChoice has implemented the following changes to allow more flexibility for inpatient stays and post-acute transfers.
These changes will be effective until March 31, 2022, but the end date may be changed. Please be sure to sign up for our provider emails so that you can receive important notifications from us.
The changes apply to inpatient admissions, skilled nursing facilities, long-term acute care, and acute rehabilitation facilities for all lines of business. Acute transfers from psychiatric stays at behavioral health facilities are excluded.
Inpatient Admissions:
QualChoice will allow notification of admission up to five days after the initial admission date and will complete medical necessity reviews once the notification is received.
Post-Acute Accommodations for Rehab Hospitals and Long-Term Acute Care Hospitals (LTACH):
QualChoice is relaxing the following requirements related to facility transfers:
- QualChoice will not require discharging acute care facilities to obtain prior authorization for patient transfers to participating post-acute facilities.
- We will not require sending facilities to provide notification of transfer to participating providers.
- However, we will require receiving facilities to notify the health plan of patient admission. We will accept notification up to five days post-transfer.
- QualChoice will continue to conduct medical necessity review.
As we will not have visibility prior to transfer, we request that hospitals utilize our in-network post-acute facilities.
Skilled Nursing Facilities:
QualChoice will allow a post-admission notification and authorize up to a seven-day stay before an additional continued stay review is required.
If you have questions about this notification or would like to speak to one of our provider relations representatives, please call us at 1-800-235-7111 (TTY: 711). Thank you for your continued partnership in helping our members live better.
