| Hospitalization FAQs
Elective Admissions
Elective inpatient stays require prior authorization. The process is the same as for all authorizations. The request is submitted to the Key Medical Group with all information documenting the medical necessity for the admission. The same 48 hour time frames apply. A copy of the authorization is faxed to both the requesting physician and the hospital where the admission is planned.
Notification
Hospitals are required to notify Key Medical Group once a patient is admitted by faxing a face sheet to 559-734-9309. When the face sheet is faxed, Key Medical Group will return the fax with a confirmation tracking notification number. If the face sheet is not returned within 48 hours contact Key Medical Group at 559-735-3892 to confirm receipt. Key Medical Group will require a medical review within 24 hours. The hospital UM Department is required to call Key Medical Group. A confidential voicemail can be left at 559-735-3892, ext 250. Patients must meet appropriate medical requirements to be inpatient.
Blue Shield
Blue Shield members assigned to Key Medical Group, hospitals will contact Key Medical Group directly for certification, see notification section. All services performed during the course of the stay, such as testing, surgery and specialist consultation are covered under the same authorization for the admission. Separate authorization is not required.
If a stay appears questionable, the Key Medical Group medical director will review the case, and if indicated, speak with the physician directly.
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Emergent Admissions
For patients who are admitted on an emergency basis, the hospital notifies Key Medical Group of the admission. If a patient is admitted from the physician office, an authorization request form is submitted, notifying the medical group of the admission but you do not need an authorization number to admit the patient on an urgent basis. The medical group will obtain review from the hospital utilization review department and days are certified based on that review. See above section for notification requirements.
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