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ATTENTION MCLAREN HEALTH PLAN PROVIDERS
Authorization Relief Measures for Inpatient Admissions
Extended Through February 14, 2022
Published: 1/24/22

In recognition of the increased number of inpatient admissions due to the most recent COVID-19 surge, McLaren Health Plan will waive inpatient hospitalization authorization as noted below:

  • Dates of Service: Nov. 22, 2021 through Feb. 14, 2022
  • McLaren facilities engaged with the APM program are not affected by this auth relief – there are no changes to the APM program
  • Inpatient hospitals are not required to obtain an authorization for any inpatient stay, regardless of diagnosis or network status (in-network or out-of-network) EXCEPTION: McLaren Health Plan Community Individual on the Exchange plan – Auth relief applies to in-network facilities only. Inpatient hospital admissions to out-of-network facilities require authorization for members with McLaren Health Plan Community Individual on the Exchange plan.
  • Hospitals are not required to obtain authorization prior to transferring a patient to the following: Skilled Nursing Facility (SNF), long-term acute care facility (LTACH), inpatient rehabilitation
  • Skilled Nursing Facilities must notify McLaren Health Plan within five business days of an admission for tracking purposes
  • Elective surgeries and/or procedures listed on McLaren Health Plan’s website as requiring preauthorization are not included in the authorization relief effort. Elective surgeries and procedure codes which require preauthorization can be found under "Service Codes that Require Authorization" and are posted here: https://www.mclarenhealthplan.org/Uploads/Public/Documents/HealthPlan/documents/MHP%20Documents/referral_catagories.pdf
  • Hospitals seeking an inpatient designation for an admission of less than 48 hours must follow the process for inpatient vs observation review: https://www.mclarenhealthplan.org/mhp/observation-reconsideration-request-mhp
  • This authorization relief package is effective for the following lines of McLaren Health Plan business:
        • McLaren Health Plan Community
        • McLaren Health Advantage
        • McLaren Health Plan Medicaid
        • EXCEPTION: McLaren Health Plan Community Individual on the Exchange Plan – Auth relief applies to in-network facilities only. Admissions to out-of-network facilities require authorization.
        • EXCEPTION: McLaren Medicare Advantage - active 1/1/22. Medicare Advantage requires inpatient authorization.
A re-evaluation of this authorization relief measure will occur every 30 days with the first review happening the week of Jan. 24, 2022. Updates will be posted here.

If you have any questions regarding this process, please contact Customer Service at 888-327-0671 (TTY: 711).

 

Forms

Provider Preauthorization Form