Some denied SNF claims for Medicare Plus Blue members will automatically process for payment after Nov. 26, 2021

Blue Cross Blue Shield of Michigan and Blue Care Network recently reviewed paid skilled nursing facility claim records with dates of service from Oct. 1, 2019, through Dec. 16, 2020, for our Medicare Advantage members. The purpose of the review was to verify that the billed services matched the services naviHealth authorized.

During the review, we found that some claims included overbilled or unauthorized services. For these claims, we sent letters to the affected providers to let them know they have 90 days to submit corrected claims that align with the services naviHealth authorized.

Note that our systems will deny some corrected claims for Medicare Plus Blue members due to untimely filing. This occurs because our systems are set up to automatically issue denials for claims that are submitted more than one year after the date of service.

You don't need to take any action as a result of the denial. We're identifying these claims and will process them for payment after Nov. 26, 2021.

This issue doesn't affect submissions of corrected SNF claims for BCN AdvantageSM members.

As a reminder, naviHealth manages post-acute care services for Medicare Plus Blue and BCN Advantage members. For more information about naviHealth, see the Post-acute care services: Frequently asked questions for providers document.

Posted: July 2021
Line of business: Blue Cross Blue Shield of Michigan