I. Prior Authorization Is Required for Inpatient Post-Stabilization Services
CalOptima Health requires both contracted and noncontracted hospitals to obtain prior authorization before admission for medically necessary inpatient post-stabilization services. Prior authorization is not required for emergency services. For the OneCare Connect (OCC) Cal MediConnect Program (Medicare-Medicaid Plan), observation status does not require an authorization. However, if the treating physician is planning to admit an OCC member under observation to inpatient, a prior authorization is required before the inpatient admission.