To obtain a copy of a specific Security Health Plan protocol, call 1-800-548-1224 or sending an email to email@example.com.
Precertification of hospital admissions
Based on medical diagnosis or proposed surgery and medical information, Security Health Plan will:
- Authorize coverage for a length of stay based on InterQual Level of Care Criteria. (Remember that the InterQual Level of Care Criteria is a minimum length of stay consistent with quality care, not an average or maximum. Actual length of coverage for a stay is based on medical necessity and intensity of service.)
- Notify the provider of the number of days for which coverage is authorized for elective admissions by phone (affiliate) or by letter (non-affiliate)
- Upon request, send a copy of the appropriate InterQual Level of Care Criteria, available by contacting the Security Health Plan Utilization Review Coordinator
- Follow the admission with the hospital Utilization Review Department if the member is not discharged within the precertified time frame. The admission will be reviewed for medical necessity and intensity of service
- Contact the provider for additional information (if not available through the hospital utilization review department) to determine whether additional days will be covered or denied based on medical necessity for an acute care setting. Alternate settings and appropriate home health services will be explored for those who do not meet criteria for continued coverage of acute care
Note: The provider, not the member, is responsible to precertify an admission to the hospital for medical and/or surgical treatment.
Contact the Security Health Plan Utilization review coordinator at 1-800-991-8109.