An inpatient request is a formal recommendation issued by a healthcare provider for a hospitalization stay, along with services rendered for during that stay. Inpatient requests can be submitted prior to the expected start date, concurrently with the stay, or retrospectively after the person has been discharged.

This user guide details the steps to enter all information for an inpatient request so that it may be submitted for review. Refer to Reviewing a Request for the review and adjudication process.

{% tabs fullWidth="false" %}

* Access to Utilization Management * Permission to create inpatient requests

When you have a request for inpatient services that needs to be reviewed for medical necessity and provider network requirements, either in advance, during, or retrospectively.

* The Units Calculator is a time saver to help with calculating the correct number of units to be requested. Refer to [Using the Units Calculator](../using-the-units-calculator.md) for help and guidelines. * The inpatient request creation workflow can be started from the UM worklist. You will need to search for the person within the request.

Starting point is the CPV of the person for whom the inpatient request is being created.

Click **New Request**, and then select **Authorization** from the menu.

**Request Category: Some options may not be available to your organization.*** Authorization: Request for approval of services or for a penalty waiver. * Grievance: File a complaint or dispute expressing dissatisfaction with the manner in which a Health Plan or a delegated entity provides health care services, regardless of whether any remedial action can be taken. * Pharmacy: Request for specialized review for medications.

### Create Authorization Request - Requester Information* Select the **Request Source**. * _(Optional)_ Enter the **Requester Name**. * _(Optional)_ Select the **Requester Type**. * _(Optional)_ Enter contact information: phone, email, and/or fax.

### Create Authorization - Request Details* Change the **Classification**, if needed.

**Request Classification - Some options may not be available to your organization.*** Prior Authorization: Request for approval before services are rendered. * Concurrent Review: Request for continued services during ongoing treatment. Commonly used for inpatient. * Post Service: Review request for services that have already been administered. Also known as retrospective review.

* Select the **Inpatient** as the **Request Type**. * Update the **Healthcare Type**, if needed * Select a **Treatment Setting**. * Select an **Urgency**. * Change the **Notification Date/Time**, if needed. It is automatically set to the current date and time.

Click **Create.**

### Person InformationThe person's demographic and enrollment information is displayed. The individual's primary active enrollment is selected by default.To choose another enrollment, select the radio button for that enrollment.

### Provider InformationA facility is required for an Inpatient request. Additional providers can be added to indicate their roles and involvement in this service.* Click **Facility Name** from the search type drop-down. * Enter the search term. * Click +**Add** on the desired facility.

The **Facility** role is automatically selected for this provider. If additional facilities are added, the role can be changed.

* To add more providers, enter a new search term and repeat the same steps. * To delete a provider, click **Remove**. * To add a temporary provider, click **Add Temporary Provider** and refer to [adding-a-new-provider.md](../../../platform-capabilities/adding-a-new-provider.md "mention").

Click **Continue** to go to the Diagnosis and Services page.

### DiagnosesA primary and admitting diagnosis must accompany all inpatient requests. The same diagnosis may serve as both the primary and admitting. If multiple diagnoses exist, the primary and admitting can be different diagnoses.* Enter the code or keywords for the diagnosis. * Click + **Add** on the desired diagnosis.

* To add more diagnoses, enter a new search term and repeat the same steps. * Click the

icon to indicate the primary diagnosis. * Click the

icon to indicate the admitting diagnosis. * To delete a diagnosis, click the

icon.

### Length of StayThis section contains the length of stay (LOS) request. The review type is applied to the length of stay and any optional services, but is able to be changed. This field determines the turn-around time.* Enter the expected **Duration.** * Select units of measure for the duration. * Manually enter the **From Date** or select from the calendar picker.

The Through Date automatically calculates based on the entered duration, units, and from date. Changing any of these adjusts the through date.

* Select the **Review Type**. * Select the **Treatment Type**.

Treatment settings are mapped to treatment type. If you change the treatment setting, you must re-select the other.

* _(Optional)_ Select a **Level of Care**. * _(Optional)_ Select a **Place of Service**.

### Services (_Optional)_Services can optionally be entered for an inpatient request. Each service can have different durations and dates, but all must fit within the date range of the LOS.* Enter the code or keywords for the service. * Click **+Add** on the desired service.

* Enter the expected **Duration** of this service. * Select a unit of measure. * Manually enter the **From Date** or select from the calendar picker.

The **Through Date** automatically calculates based on the entered duration, units, and from date. Changing any of these adjusts the through date.

* _(Optional)_ Change the **Review Type**. * Enter the number of **Units** to be provided for this service. * Select a unit of measure. * _(Optional)_ Change the **Treatment Type** or **Place of Service.** They are pre-populated with the same values selected for the LOS. * _(Optional)_ Enter modifiers. * To add more services, enter a new service search term and repeat the same steps. * Click the

icon to indicate the primary service. * To delete a service, click the

icon.

Click **Continue** to move to the **Attachments** page.

### Attachments (Optional)Supporting documents can be attached to the created request. Refer to [#adding-a-file-type-attachment](../management/managing-request-attachments.md#adding-a-file-type-attachment "mention")

Click **Continue** to move to the **Review** page.

### Review and SubmitReview all details of the request prior to submitting it for review. If you need to make changes, click the pencil

icon to be navigated directly to that section.

* Click **Submit** to finalize the information entered. * (_Alternate)_ Click **Delete Draft** to return to the CPV without saving the inpatient request.

After successful submission of the inpatient request for review, a summary is presented. The request status is shown, and you have the option to go **Back to CPV** or **View Request**.

If your workflow started from the worklist, the options will be **Back to Worklist** or **View Request**.