UM Operations
Level of Care
Draft — pending verification
This reference entry has not yet been verified against its authoritative source (Original definitions; regulatory facts to be verified against CMS-0057-F (89 FR 8758) and X12/HL7 documentation). Do not rely on it for production configuration until this notice is removed.
In more depth
Level-of-care criteria drive concurrent review and post-acute placement decisions, and they are the substance behind many partial certifications (HCR A2) and modifications (A6). Inpatient-vs-observation determinations in particular carry major payment consequences and their own regulatory history.