Notification Of Inpatient Admission

NOTIFICATION OF INPATIENT ADMISSION. This form is used to notify the New Mexico Workers' Compensation Administration (WCA) about the inpatient admission of a workers' compensation claimant. It is required under NMAC 11.4.7.12 (B)(1). The form collects information about the injured worker, the treating physician, the insurance carrier or third-party administrator (TPA), and details about the inpatient admission, including diagnosis, planned treatments, and the proposed length of stay. It helps ensure that the insurance carrier or TPA is aware of the admission and whether it has been authorized. If the admission has not been authorized, the form provides a means for submitting medical records for further review and assistance by the WCA Medical Cost Containment Bureau. www.FormsWorkflow.com