Hospital Inpatient Care Criteria

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TO: Hospital Providers

RE: Hospital Inpatient Care Criteria

Effective October 1, 2024, the document titled Inpatient Care Criteria has been updated. Alabama Medicaid utilizes the Adult and Pediatric Inpatient Care Criteria, Severity of Illness (SI) / Intensity of Service (IS), for utilization review, billing, and reimbursement purposes for inpatient hospital admissions and concurrent stays. This document may be accessed here:https://medicaid.alabama.gov/content/4.0_Programs/4.4_Medical_Facilities/4.4.1_Hospital_Services.aspx.

Additional information regarding inpatient admissions is in Chapter 19 of the Provider Billing Manual. Providers with policy questions may contact Medical Services at [email protected].

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