HealthPlus requires that contracted and non-contracted facilities and PPO members notify HealthPlus of a hospital admission within 24 hours by telephone or fax:
Phone: 810-230-2105 or 800-332-9161
You will be asked to provide the following information:
Member information, including name and HealthPlus Subscriber Number
- Hospital name
- Admission date and dates of service
- Names of admitting and attending physicians
- Admitting diagnosis
Clinical information supporting inpatient admission (i.e., InterQual Criteria)
- Route of admission
- Telephone number of the Facility Utilization Department
The utilization reviewer also performs admission review on cases involving members who receive services at non-participating (out-of-network) facilities. Members in stable condition and deemed appropriate for transportation by the attending physician may be transferred to a participating facility for continued treatment. Members who are not in stable condition and require continued care, will remain at the facility and be followed via telephone or fax.
All cases which do not satisfy the specified guidelines to the appropriate medical director for review and determination.
Discharge planning is a critical component of the utilization management process that begins upon admission. Discharge planning helps the patient prepare for continuing care needs, including:
Case Management Program,
Disease Management Program
departments can provide additional assistance.
For more information about the HealthPlus inpatient admissions process, please contact Customer Service at 800-332-9161.