Clinical review requirements suspended through May 31 for all admissions to acute care hospitals and for transfers to skilled nursing facilities

To enable inpatient medical facilities to prioritize patient care during this challenging time, we've already suspended the requirement for clinical review of acute care admissions of Blue Cross Blue Shield of Michigan and Blue Care Network members with COVID-19-related diagnoses.

Based on the evolving nature of this crisis, we have approved several other actions, effective immediately:

• Acute care hospitals: Clinical review requirements at all acute care hospitals for all diagnoses are suspended. This applies to all medical admissions.
• Post-acute care facilities: Clinical review requirements for the first three days of all skilled nursing facility admissions are suspended for members who are transferring from an acute care hospital.

How to submit these requests

• For acute care admissions, no clinical review is required.
• There is an important notification step to take. Eligible facilities must submit a plan notification for each admission so that an authorization is in our system when we receive the claim. We strongly encourage facilities to submit plan notifications through our e referral system. When facilities use e referral, they won't wait on hold on the phone. We're updating the e-referral system to automatically approve these requests without clinical review. While we're updating the system, some requests may pend, in error. In those cases, our staff will provide approval to the facility within two hours of submission during normal business hours.

Note: We reserve the right to audit these admissions at a later date.

• For post-acute care admissions:
• There is an important notification step to take. For SNF admissions, we're suspending clinical review requirements for the first three days when patients are transferred from an acute care hospital. However, facilities must submit a plan notification for each admission so that an authorization is in our system when we receive the claim. Facilities are not required to submit clinical documentation until the continued stay review, starting on the fourth day of stay.
• Inpatient rehabilitation and long-term acute care admissions still require clinical review. Blue Cross has adjusted our clinical review process to expedite these requests. A determination will be made within two hours, during normal business hours.
• Continue to submit Blue Cross' PPO and BCN HMO^SM post-acute requests through the e referral system or by fax. A decision will be provided within 2 hours during normal business hours.
• Continue to submit Medicare Plus Blue^SM PPO and BCN Advantage^SM SNF post-acute admission requests to naviHealth. A decision will be provided within 2 hours during normal business hours.

Important!

These changes are in effect through May 31, 2020, and apply to Michigan facilities, for all lines of business, including Blue Cross' PPO, BCN HMO, Medicare Plus Blue and BCN Advantage.

Exception: These changes do not apply to Flexlink^® groups for which a third-party administrator makes authorization determinations. Facilities should check the back of the member's ID card to determine whether a third-party administrator needs to be contacted prior to an admission.