Ambetter: Prior Authorization changes effective through 03/01/2022

Date: 02/02/22

Ambetter (Marketplace):

02/02/2022 Update: Prior authorization changes have now been extended for Ambetter through 03/01/2022.

 

To support the Ambetter membership and Ambetter Provider Network, the following changes will be effective through January 31, 2022:

Inpatient Admissions:  Ambetter will allow notification of admission up to 5 days post admission date and complete medical necessity reviews when notification is received.

Post-Acute Accommodations for rehab hospitals and Long Term Acute Care hospitals (LTACH):

Ambetter will relax our requirements related to facility transfers including:

a. Ambetter will not require discharging acute care facilities to obtain prior authorization for patient transfers to participating post-acute facilities. 

b. Ambetter will not require sending facilities to provide notification of transfer to participating providers. 

c. However, Ambetter will require receiving facilities to notify the health plan of patient admission.  Ambetter will accept notification up to five days post-transfer.

d. Ambetter will continue to conduct medical necessity review

e. Because Ambetter will not have visibility prior to transfer, Ambetter request that hospitals utilize our in network post-acute facilities

Skilled Nursing Facilities: Ambetter will allow post admission notification and authorize up to a 7 day stay before medical necessity continued stay review.

If you have any questions, please contact Provider Relations at 1-844-385-2192 (TTY 711).