Reminder: Starting Oct. 1, 2019, naviHealth will authorize PDPM levels for Medicare Advantage SNF admissions
For Medicare Plus BlueSM PPO and BCN AdvantageSM skilled nursing facility admissions with dates of service on or after Oct. 1, 2019, naviHealth will authorize patient-driven payment model levels during the patient's stay (from preservice through discharge) to align with the Centers for Medicare & Medicaid Services payment methodology. We first communicated this change in late July.
When submitting claims for stays with dates of service starting on or before Sept. 30, 2019, and extending through or beyond Oct. 1, you'll need to include both the resource utilization group levels and the PDPM levels that naviHealth authorized.
Medicare Plus Blue PPO and BCN Advantage follow CMS payment methodology for skilled nursing facilities. As a result, the payment methodology will change from RUG levels to PDPM levels on Oct. 1, 2019.
You can view additional information on The Patient Driven Payment Model (PDPM) - Information and Resources for Provider Partners page of the naviHealth website.*
As a reminder, naviHealth manages authorization requests for Medicare Plus Blue PPO and BCN Advantage members admitted to post-acute care on or after June 1, 2019. For details, see the Post-acute care services: Frequently asked questions by providers document.
*Blue Cross Blue Shield of Michigan and Blue Care Network don't own or control this website.
Posted: September 2019
Lines of business: Blue Cross Blue Shield of Michigan and Blue Care Network