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UPDATED: Timeframe for Clinical Information for Acute Inpatient Facility Providers

Date: 04/12/24

This notice is to inform hospital acute facility providers of the revised timeframe for submitting clinical information related to an acute inpatient admission of a Superior member. This change is to ensure adequate time is allowed to complete the utilization review process for the benefit of Superior’s members, and to afford facilities and admitting providers all available opportunities to substantiate the medical necessity of the admission. 

Effective May 13, 2024, acute inpatient facility providers should submit all clinical information that was not provided with the notification of admission to Superior by 12:00 p.m. (noon) on the next day following notification of admission. 

This modification will enhance our ability to review the case to determine medical necessity, offer and facilitate a discussion between the member’s admitting provider and Superior’s Medical Director prior to adverse benefit determination, if the clinical information received does not confirm medical necessity of the admission. 

Providers will be notified by the concurrent review nurse of the opportunity for peer-to-peer discussion, as applicable, by phone or fax. Fax only facilities will receive communication by fax.

We appreciate your cooperation as we implement this modification within our current process. This will help to ensure that we are timely and appropriately completing our utilization review and ensuring the delivery of all medically necessary care for our members.

For any questions, please contact your Account Manager. To access their contact information visit Find My Account Manager.