New Form for Extending Inpatient Admissions

Friday, September 1, 2023

Health Net Federal Services, LLC (HNFS) has a new form available to request an extension for an authorized inpatient stay. If the attending physician determines that a TRICARE beneficiary requires additional inpatient treatment beyond the initially approved duration, please complete and submit our new Inpatient Concurrent Review Form. Using this form will ensure HNFS has the necessary information to help expedite the review process.

Please refer to these questions and answers about the Inpatient Concurrent Review Form.

When should the form be used?

Complete this form if your facility needs to extend an authorized inpatient stay for a TRICARE West Region beneficiary.

Is the form required?

Yes. For HNFS to issue an extended inpatient treatment determination, we must receive a completed Inpatient Concurrent Review Form within 72 hours of the last authorized date of service listed in the beneficiary’s inpatient admission approval.

Who should complete and submit the form?

Your facility’s utilization management or utilization review team should complete and submit the form.

Does anything else need to be submitted with the form?

Submit the last five days of the attending physician’s notes along with a completed Inpatient Concurrent Review Form.

How should the form and provider notes be submitted?

Fax a completed Inpatient Concurrent Review Form along with the last five days of the attending physician’s notes to HNFS at
1-866-678-0615. Important: HNFS will not accept incomplete forms or clinical/medical records submitted in place of a completed Inpatient Concurrent Review Form. All required materials must be faxed to HNFS within 72 hours of the last authorized date of service listed in the inpatient admission approval.

Is the Inpatient Concurrent Review Form different from HNFS’ Inpatient TRICARE Service Request/Notification Form?

Yes. Use the Inpatient Concurrent Review Form to extend an already-approved inpatient admission past the last authorized date of service. Our Inpatient TRICARE Service Request/Notification Form is submitted before a TRICARE patient is admitted to a facility or when notifying HNFS that a TRICARE beneficiary has just been admitted to your facility.

Visit our Hospitalization for Medical and Surgical Care and Hospitalization for Mental Health pages for more information about hospitalization benefits.