Covered and Noncovered Services : Covered Services and Requirements

Continuous Stay Policy

ForwardHealth considers all hospital services to be part of a single, continuous inpatient stay when the services occur contiguously and the member is eventually granted inpatient status.

Providers are required to include on an inpatient claim all services provided during an outpatient visit that is contiguous with an inpatient stay for the member. That is, outpatient services provided to the member being admitted to the hospital and subsequently being counted in the midnight census are submitted on the inpatient claim.

For example, if a member enters the ER on January 1 and receives care, is admitted to the hospital on January 2 (and is counted in the midnight census on January 3), and is discharged from the hospital on January 3, ForwardHealth considers the outpatient services provided on January 1 to be part of the inpatient stay. The entire visit is an inpatient stay and must be submitted on an inpatient claim even though the services provided to the member in the ER as an outpatient were not provided on the same DOS as the inpatient admission. Providers may not submit a separate outpatient claim for this continuous stay.