Additional BCN Local Rules for acute care and skilled nursing facility services go into effect May 2

Effective May 2, 2016, Blue Care Network's Care Management staff will begin using additional BCN Local Rules when making determinations on clinical review requests for acute care services and skilled nursing facilities. This applies to members with coverage through BCN HMO^SM (commercial) and BCN Advantage^SM products.

These Local Rules are:

• Infection GI/GU/GYN: Diverticulitis
• Gastrointestinal or biliary: Dehydration or gastroenteritis
• Gastrointestinal or biliary: Jaundice or bilirubin
• Gastrointestinal or biliary: Pancreatitis, chronic
• Genitourinary: Acute kidney injury
• Deep vein thrombosis
• Diabetes
• Syncope
• Infection: General
• Major joint arthroplasty for rehabilitation and skilled nursing facility
• Pain management for skilled nursing facility

These Local Rules will be added to the McKesson Corporation's 2015 InterQual^® criteria now in use. They will be published in the May-June 2016 issue of BCN Provider News, which will be available online at the end of April.

Posted: March 2016
Line of business: Blue Care Network