Professionals

Medicaid

• Acute Care Hospital Review
• Acute Care Hospital Review Forms
• Chronic Disease Hospital Review
• Chronic Disease Hospital Review Forms

Acute Care Hospital Review

Certified to conduct utilization review in Connecticut and Rhode Island, Qualidigm reviews requests for acute care hospital services. Our staff nurses look at the type of care and services that hospitals or their physicians request and the appropriateness of the setting for needed care. These utilization review services also include requests for out-of-state inpatient hospitalizations or services, inpatient rehabilitation and transplant services.

Tools & Resources

• Guidelines for Medical Record Documentation for Observation Services in CT
• Clarification in the Processing of Behavioral Health Related Inpatient Claims for the State of CT Administered General Assistance (SAGA) Clients
• Connecticut Medical Assistance Program 
• Connecticut Medicaid Authorization Tips
  
  
• CONNCUR Hospital Memo: February 8, 2010
  

 Acute Care Service Review Forms

• CONNCUR Prepayment Review Form
• CONNCUR Special Review Form (Emergency Admissions)
  
  
• CONNCUR Medicaid Medical Review Form
• CONNCUR Medicaid Psych/Detox Review Form

Acute Care Hospital Review | Chronic Disease Hospital Review 

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Chronic Disease Hospital Review

Qualidigm is responsible for reviewing Medicaid clients in Connecticut and border state chronic disease hospitals (CDHs). This process is in accordance with section 17b-262-787 of the Regulations of Connecticut State Agencies as implemented by the Department of Social Services (DSS). The initial phase of this review involves patients admitted to CDHs beginning December 1, 2009.

A separate process will be used to review the continued stay for eligible clients who were admitted prior to December 1, 2009. A third process will be used to review clients who were not eligible at the time of admission, but who are granted eligibility during their stay or after discharge. The implementation date and description of those processes will be communicated by DSS and Qualidigm at a later date.

 Tools & Resources

• Chronic Disease Hospitals CONNCUR Authorization Review Process

 Chronic Disease Hospital Review Forms

• CDH Admission/Readmission Review form
• CDH Continued Stay Review Form
• CDH Continued Stay for Placement Review Form

Acute Care Hospital Review | Chronic Disease Hospital Review 

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