What ADT is
ADT stands for Admit, Discharge, Transfer. ADT messages are real-time event notifications a hospital or facility sends through the HL7 version 2 messaging standard whenever a patient's status changes. They carry patient demographics and visit information, and they are the most widely implemented HL7 v2 message type in healthcare.
Each ADT message carries an event code that says what happened. ADT A01 is an admit or visit notification. ADT A03 is a discharge or end-of-visit notification. ADT A02 is a transfer, A04 is a register, and A08 is an update to patient information. For value-based care, the A01 admit and the A03 discharge are the events that matter most, because they open and close the inpatient stay that drives transitions-of-care work.
Why ADT matters in value-based care
ADT is the only feed fast enough to act on a hospital stay while there is still time to intervene. A claim for the same admission arrives weeks to months later, long after the follow-up window has closed. An ADT discharge message arrives within minutes to hours, which is what makes it the trigger for transitions-of-care outreach.
That timing maps directly to how readmissions and transitions are scored. The 30-day window after discharge is when avoidable readmissions concentrate, and the Medicare transitional care management service requires an interactive contact with the patient within 2 business days of discharge. Without a near-real-time ADT feed, a care team learns about a discharge too late to make that contact or to schedule the follow-up visit that keeps the patient out of the hospital.
How ADT feeds are sourced and used
Care teams rarely connect to each hospital one at a time. ADT events flow through intermediaries that aggregate notifications across many facilities:
- Health information exchanges (HIEs). Regional and statewide HIEs collect ADT events from participating hospitals and route them to the patient's care team, payer, or accountable care organization.
- ADT notification networks. National event-notification services aggregate admit, discharge, and transfer alerts and deliver them as a single feed, often the practical way an IPA or ACO gets coverage across the hospitals its members use.
- CMS-driven adoption. CMS interoperability rules require many hospitals to send electronic admission, discharge, and transfer notifications, which has made ADT feeds far more complete than they were a few years ago.
Once received, an ADT discharge event becomes a worklist item: confirm the discharge, reconcile medications, make the interactive contact inside 2 business days, and book the follow-up visit inside the 7-to-14-day window that transitional care management defines.
Common mistakes teams make with ADT
- Tolerating feed latency. An ADT discharge that arrives days late has already missed the 2-business-day contact deadline. Latency, not just coverage, decides how many transitions a team can work in time.
- Incomplete hospital coverage. If the feed only includes a few hospitals, members discharged from facilities outside the network go unworked. Coverage gaps look like a quiet panel when they are really a blind spot.
- Treating every event as urgent. ADT carries dozens of trigger events. Without filtering to the A01 admit and A03 discharge events that matter, teams drown in registration and update noise.
- Routing alerts to a static inbox. An ADT alert that lands in an unmonitored mailbox is the same as no alert. The event has to flow into an outreach queue with an owner and a deadline.
- Duplicate outreach across teams. When risk, quality, and care management each receive the same ADT feed separately, one discharged member can get three calls. The feed needs one shared queue, not three parallel ones.
How Pelica handles ADT
Pelica's Care Management Copilot ingests ADT feeds in real time and turns each discharge event into a transitions-of-care worklist item, tracks the 5-day follow-up window, and routes everything into one outreach queue so risk, quality, and care management are not calling the same member three times. Across Pelica deployments, customers close 70%+ of TRC gaps within 30 days and reach a 75% follow-up rate on the FMC 7-day measure.
Related terms
ADT sits at the front of the transitions-of-care cluster. TCM (Transitional Care Management) is the Medicare service that an ADT discharge event triggers, with its 2-business-day contact and 7-to-14-day visit rules. Readmission is the avoidable event that timely ADT-driven follow-up is meant to prevent.