We've resolved issues with processing SNF claims for Medicare Advantage members

This is an update to a message originally posted on Nov. 25, 2019.

We updated our systems to resolve the issues we were experiencing with processing some skilled nursing facility claims for Medicare Plus Blue^SM PPO and BCN Advantage^SM members.

On Dec. 8, 2019, we resumed regular processing of these SNF claims, and we began processing any SNF claims we'd been holding.

We previously notified you of the following:

• For Medicare Plus Blue member claims denied with a message stating that you needed to resubmit with a HIPAA valid CPT code, we told you that you didn't need to do anything and that we would reprocess these claims when the issue was fixed.
• For BCN Advantage member claims denied with a message stating that you need to resubmit with valid codes, we told you to resubmit these claims with the same PDPM levels. We noted that you would have received a letter stating that these claims were denied and would need to be resubmitted with valid codes.

We apologize for any inconvenience.

As a reminder, naviHealth authorizes PDPM levels during the patient's stay (from preservice through discharge) for dates of service on or after Oct. 1, 2019, to align with CMS payment methodology. naviHealth works with SNFs to ensure the biller submits the appropriate PDPM level for reimbursement.

For more information, see the Post-acute care services: Frequently asked questions by providers document.

Posted: December 2019
Lines of business: Blue Cross Blue Shield of Michigan and Blue Care Network