Inpatient Utilization Review

Providing Inpatient Admission Notification and Utilization Review for PacificSource Community Solutions Members.

PacificSource requires notification of all inpatient hospital admissions. Notification allows for timely and effective discharge planning as well as the identification of patients in need of Case Management.

Submission of inpatient admission notification and utilization review may be initiated either online or by fax.

Note: When notification and initial UR (if available) is entered online, a reference number (UM/Auth #) is instantly provided and review decision/communication is completed more efficiently than when submitted by fax.

Online

  1. Fax inpatient admission notification (facesheet) to (541) 330-7339 within one business day of admission
  2. Concurrent review or extended stay review may be provided by completing the UR Submission Form and faxing to (541) 330-7339
  3. Completed notifications/UR will be reviewed by a Nurse Reviewer and a goal length of stay (GLOS) will be assigned per Milliman or InterQual criteria
  4. If the member's anticipated LOS is longer than the number of days originally authorized, a concurrent review will be required. This additional UR summary (using the same form as above) will need to be faxed to (541) 330-7339

Fax

  1. Fax inpatient admission notification (facesheet) to (541) 330-7339 within one business day of admission
  2. Concurrent review or extended stay review may be provided by completing the UR Submission Form and faxing to (541) 330-7339
  3. Completed notifications/UR will be reviewed by a Nurse Reviewer and a goal length of stay (GLOS) will be assigned per Milliman or InterQual criteria
  4. If the member's anticipated LOS is longer than the number of days originally authorized, a concurrent review will be required. This additional UR summary (using the same form as above) will need to be faxed to (541) 330-7339