QUEST Integration – Pre-admission Testing

Original Effective Date:

08/01/1994

Current Effective Date:

01/01/2015

Preadmission screening and testing must be done before a QUEST Integration patient is hospitalized. Most patients requiring surgery are admitted on the date of surgery. If admission on the day of surgery creates a significant medical risk to your patient and could result in increased post-surgical complications or length of stay, please request precertification for a prior-day admission.

Examples

The following are examples of patients for which extensive preparation before surgery may be required and a request for precertification of a prior-day admission should be submitted.

• A patient with significant medical risk factors that could compromise the patient’s outcome and recovery (such as a brittle diabetic undergoing major surgery, and who has documented evidence of having tried to stabilize blood sugars on an outpatient basis)
• A patient with severe, multiple system disease requiring study and treatment before surgery or further treatment (for example, a patient who needs hydration, IV antibiotics and intestinal decompression)

Obtaining Precertification for Prior-day Admission

• Call HMSA’s Precertification Unit Monday through Friday between 8 a.m. and 4 p.m. two or more working days before the planned admission.
• On Oahu: 808-948-6464
• From Neighbor Islands: 1-800-344-6122
• If you call after hours, please leave a voice mail message at these numbers. You also may fax information to 808-944-5611, Precertification Unit.
• Provide your patient’s QUEST Integration number and the medical indication(s) for early admission.

If your request is denied, you may appeal by providing additional medical information within 30 days. In the meantime, you should proceed with any service that you determine to be medically appropriate for your patient. If a patient chooses to be admitted before the date of surgery even though prior-day admission was denied, the patient must sign a statement indicating that he/she understands the admission was not authorized and accepts financial responsibility for the additional charges associated with the denied prior-day admission. Please be sure the patient is fully apprised of his or her financial responsibility in this situation.

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