iEXCHANGE® Inpatient Certifications
The Utilization Management (UM) Department reviews Inpatient Precertifications not completed in iEXCHANGE. The UM Department may be reached at 1-800-672-2378. Telephones are answered by UM personnel from 7:30 AM to 5:00 PM, CST, Monday through Friday and non-legal holidays. Messages may be left in a confidential voice mailbox after business hours.
All inpatient admissions may be initiated through the iEXCHANGE Web application with the exception of Behavioral Health and/or Substance Abuse admissions for BlueLincs HMO members. Authorizations for these admissions must be obtained through Magellan Behavioral Health. Often the transaction can be authorized based on a few data elements without additional information being required. In the event your case is not immediately approved by iEXCHANGE, your case will be referred to the Utilization Management Department for review.
If a patient is admitted as an inpatient to the hospital; does the hospitals' Inpatient Precertification cover the physician?
The admitting and/or attending physician is required to obtain an inpatient precertification for an inpatient hospital confinement. Once complete, the inpatient precertification does cover all services provided within the approved authorization period for the level of care authorized.
Yes. You will need to sign up for an iEXCHANGE ID, User ID and password. Instructions are located in the iEXCHANGE section of the Blue Cross and Blue Shield of Oklahoma (BCBSOK) Web site.
Yes, the Extension Functionality to extend an existing Inpatient Certification is available and can be accessed through the "Extend Inpatient" process. All Extension requests will pend for review by BCBSOK clinical staff.
This means that your case is being reviewed by the UM Department. You can check the status through the Search feature in the Web application for any updates. Generally, you should see an update by the end of the following business day. Please refer to the Web Reference Guide. If you need to speak with the UM Department, call 1-800-672-2378.
Why does iEXCHANGE not allow set up of an Inpatient Precertification for certain procedures and diagnoses?
BCBSOK's business needs will continue to require certain procedures and diagnoses to be reviewed by our clinical staff for medical necessity (i.e. focus review, experimental and investigational, etc.) iEXCHANGE will continue to support BCBSOK's business need.
Can a retroactive Inpatient Precertification be entered in iEXCHANGE? If so, within how many hours/days?
Yes. Retro Inpatient Precertifications are allowed as long as the patient remains in the hospital or no longer than five (5) days post discharge.
Yes, you will be able to perform treatment searches or inquiries for Inpatient Precertifications. Inquiries may be made through the Treatment Search or Treatment Update options. A Case ID is not required to search iEXCHANGE. Please refer to the Web Reference Guide.