CurrentHealth NetPolicy N/A

Emergency Services — Admission Notification and Definitions

Defines what constitutes an emergency medical condition and emergency services and sets requirements for hospital and participating provider group notification and admission reporting to Health Net units. Applies to Health Net participating hospitals and physician groups handling member emergency admissions.

Policy Summary

PayerHealth Net

PolicyEmergency Services — Admission Notification and Definitions

Policy CodePolicy N/A

Change TypeAdministrative/Operational (no material clinical changes)

Effective DateN/A

Next Review DateN/A

Key ActionHospitals must contact the Hospital Notification Unit within 24 hours (or one business day for weekend admissions) and send the hospital face sheet; participating physician groups must notify Medical Management and provide the PPG authorization number when applicable.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

24 hrs / 1 business dayHospitals must notify HNU of admissions

800-676-7969Employer MA HMO fax

800-995-7890MA HMO phone

Prudent laypersonDefinition basis

Emergency Services Coverage & Admission Notification

Emergency services definitions and admission notification requirements

Operational requirements and definition-based coverage stance for emergency services admissions reporting.

Emergency medical condition is defined by the prudent layperson standard: acute symptoms of sufficient severity that a prudent layperson could reasonably expect lack of immediate medical attention to result in serious jeopardy to health (including for a pregnant woman and her unborn child), serious impairment of bodily functions, or serious dysfunction of any bodily organ or part.

Emergency services are covered when furnished by a provider qualified to provide emergency services and are needed to evaluate or treat an emergency medical condition.

For hospital admissions originating in a participating hospital's emergency department, the treating ED must complete and send the hospital face sheet to the Hospital Notification Unit (HNU).

Participating physician groups (PPGs) must notify the Medical Management Department and provide the PPG authorization number when treatment has been authorized.

Policy Summary

PayerHealth Net

PolicyEmergency Services — Admission Notification and Definitions

Policy CodePolicy N/A

Change TypeAdministrative/Operational (no material clinical changes)

Effective DateN/A

Next Review DateN/A

SourceLink

On This Page

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Notifications, Submissions, and Authorization Requirements

Prior Authorization

Hospital face sheet submission

The treating emergency department of a participating hospital must complete and send the hospital face sheet to the Hospital Notification Unit (HNU) for all hospital admissions. Hospitals are required to contact the HNU within 24 hours of an admission, or by one business day when an admission occurs on a weekend.

Hospitals must contact the HNU within 24 hours of an admission, or one business day when an admission occurs on a weekend.
Hospitals should use the applicable fax or phone number for the member type when contacting the HNU (see HNU contacts in the full policy).

Documentation Required

PPG notification and authorization number

Participating physician groups (PPGs) must notify the Medical Management Department and supply the PPG authorization number when treatment has been authorized.

PPGs must supply the PPG authorization number if treatment has been authorized.

Key Definitions

Emergency medical condition

Definition basisCondition manifesting with acute symptoms of sufficient severity that a prudent layperson could reasonably expect that absence of immediate medical attention would result in serious jeopardy to health, serious impairment of bodily functions, or serious dysfunction of any bodily organ or part (includes pregnant women and unborn child considerations).

Severity examplesIncludes severe pain or other acute symptoms indicative of immediate risk to health or bodily function.

Prudent layperson standardAssessment is based on what a prudent layperson with average knowledge of health and medicine would reasonably expect.

Emergency services

Scope of servicesCovered inpatient and outpatient services needed to evaluate or treat an emergency medical condition.

Provider qualificationServices must be furnished by a provider qualified to provide emergency services.

Connection to conditionCoverage applies when services are needed to evaluate or treat a condition meeting the emergency medical condition definition.

Hospital Notification Unit (HNU)

Notification timingHospitals must contact the Hospital Notification Unit (HNU) within 24 hours of an admission, or one business day when an admission occurs on a weekend.

Employer group MA HMO fax800-676-7969

Employer group MA HMO phone800-995-7890

Individual MA HMO fax844-825-8045 (does not apply to employer groups)

Individual MA HMO phone800-995-7890 (does not apply to employer groups)