December 27, 2012
All Blue Cross Contracting ProvidersFrom:
Connie Winkley – Education/Communication Coordinator
Institutional Provider Relations
Blue Cross and Blue Shield of Kansas, Inc.
An Independent Licensee of the Blue Cross and Blue Shield Association
Selecting Episode Day in InterQual for Electronic Inpatient Precertification
The information provided below is not new information. BCBSKS is providing this information as a review due to several recent inquiries from our contracting providers on how to determine the Episode Day when submitting clinical information into InterQual for an electronic inpatient precertification of a BCBSKS member.
When the initial precertification is electronically submitted the admission date for the patient is counted as Episode Day 1 when choosing the Episode Day in InterQual. The admission date always counts as Episode Day 1. When a Continued Stay Review (CSR) is being submitted and the condition subset remains the same, then the Episode Day submitted into InterQual for the CSR should be counted with the admission day as Episode Day 1 and each subsequent day counted as an Episode Day.
When a CSR is being submitted and the condition subset changes (a condition subset is chosen for the CSR, which is different from the condition subset that was chosen on Episode Day 1 with the initial precertification), then the Episode Day count starts over with Episode Day 1 for the CSR.
Information on submitting electronic inpatient precertification of BCBSKS members can be found on the BCBSKS Website, including the Precertification Manual and FAQs. Click on the link below to view the BCBSKS Precertification Web page.
BCBSKS Inpatient Precertification
Additional electronic precertification information can be found in the following newsletters, which were published in 2012 regarding the upgrade of the InterQual system on the BCBSKS Website.
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If you have questions regarding precertification, please contact your Institutional Provider Representative or one of the BCBSKS contacts below.
Education/Communications Coordinator – 785-291-7236
Precertification Department – 1-800-782-4437