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Inpatient Care Guidelines - Chapter Table of Contents Published: October, 2001 Pre-Authorization/Authorization All referrals are based on PBH's Medical Necessity criteria and require Pre-Authorization...more   Inpatient Eligibility and Accessibility PBH is available for eligibility verification 24 hours a day/seven days a week...more   Utilization Management For effective management of treatment planning, it is imperative that the facility establish the following parameters...more   Inpatient Care Management Discharge planning should begin at the time of admission...more   Facility Credentialing/Recredentialing Facility credentialing occurs prior to contracting; recredentialing occurs every three years...more   Medical Staff At non-inclusive contracted facilities, only those doctors credentialed and contracted with PBH can be utilize...more   Billing and Reimbursement Complete a Universal Claim form UB 92 (HCFA 1450) and submit bills within 90 days of the discharge date...more   Non E.R. Admits Through Emergency Departments Facilities are discouraged from routinely referring admissions through their Emergency Department...more   Emergency Referrals If a member is in imminent danger of harm to self or others or appears to be gravely disabled...more Back to Top