Inpatient hospital services are items and services ordinarily furnished by the hospital for care and treatment of inpatients and are provided under the direction of a licensed practitioner (physician or dentist with staff affiliation) of a facility maintained primarily for treatment and care of injured, disabled or sick persons. Such inpatient services must be medically justified, documented, certified and re-certified by the Quality Improvement Organization (QIO) and may be reimbursed by Medicaid if provided on a Medicaid covered day.

A Medicaid covered day is a day for which the recipient is Medicaid eligible, the patient's inpatient benefit has not been exhausted, the inpatient stay is medically necessary, the day is not part of a hospital stay for a non-payable procedure or non-authorized procedure and the claim is on time.