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Provider Manual

Two Midnight Rule

Last Updated on August 28, 2018

In line with the recent Centers for Medicare and Medicaid Services suspension of the Two Midnight Rule, effective immediately Security Health Plan will also suspend implementation of this rule. Please follow the updated process below when submitting clinical information for both inpatient admissions and observation admissions:

Inpatient admissions

  1. Notify Security Health Plan within 24 hours or the next business day of the admission
  2. Fax the following within 24 hours of notification of admission to Security Health Plan Health Services at 715-221-9980
  • Clinical information
  • Inpatient order
  1. After all information is received, Security Health Plan will review the case and make the determination
  2. If no clinical information is received within 70  hours of notification date and time, associated claims will be denied to the provider as a provider contract requirement

 Observation admissions

  1. Notify Security Health Plan within 24 hours or the next business day of any observation admission greater than one midnight
  2. Fax the following within 24 hours of notification of admission to Security Health Plan Health Services at 715-221-9980
  • Clinical information
  1. After all information is received, Security Health Plan will review the case and make the determination
  2. If no clinical information is received within 70  hours of notification date and time, associated claims will be denied to the provider as a provider contract requirement

 For DRG facilities, approved inpatient admissions will require only the initial clinical review; you must also provide Security Health Plan with a discharge date.

Critical Access Hospital reviews must be completed on both inpatient and observation patients; Security Health Plan will provide you with the number of days certified. In the event you require more days than originally certified, you must submit an additional request 24 hours prior to the member’s authorization expiration date.

  • For inpatient-only admissions, the provider needs to provide the inpatient order as well as clinical information to Security Health Plan within 24 hours of admission to certify the patient’s inpatient admission. 
  • If the provider fails to provide the needed clinical information within 24 hours of the admission, Security Health Plan will deny for provider contract requirement. Each day will be denied to the provider until Security Health Plan receives required clinical information.  

 If you have any questions about this information, please call our provider customer service line at 1-800-548-1224, Monday through Friday from 8 a.m. to 5 p.m.