Assistance is available for post-acute care placements
Blue Cross Blue Shield of Michigan, Blue Care Network and naviHealth recognize the strain that the rise in COVID-19 hospitalizations has placed on our hospital partners, and we’re here to help.
If you're struggling to find placements in skilled nursing facilities, inpatient rehabilitation facilities or long-term acute care hospitals for members with Blue Cross commercial, Medicare Plus BlueSM, BCN commercial or BCN AdvantageSM plans, follow these suggestions, which will allow us or naviHealth to support these transitions.
- For Blue Cross commercial and BCN commercial members: Submit prior authorization requests for post-acute care through the e-referral system. Enter a note in the Notes section if you need help placing the patient.
- For Medicare Advantage members (Medicare Plus Blue and BCN Advantage): Let naviHealth know that you're having trouble placing members when you submit prior authorization requests. naviHealth will assist you with placing members, using data they're collecting on post-acute care facility and hospital acceptance, placement and closures.
Be sure to include the hospital face sheet with the following information: Member name and ID; name and NPI of the attending or ordering provider; requested level of care; and the preferred facility name, NPI and address.
You can also request assistance by calling naviHealth at 1-855-851-0843 or by entering the request for assistance on the hospital face sheet that you send to naviHealth with the prior authorization request.
For any questions, please reach out to your naviHealth provider relations manager. If you aren't sure who your naviHealth provider relations manager is, send an email to umproviderconcerns@bcbsm.com.
Skilled nursing facility information
Although clinical review requirements are temporarily suspended for admissions from acute-care hospitals to skilled nursing facilities, Blue Cross, BCN and naviHealth continue to be responsible for managing authorizations for members who meet waiver criteria once they're admitted to a post-acute care setting. (See this Provider Alert (PDF) for details about the temporary suspension of clinical review.)
When transferring members to SNFs, continue to notify Blue Cross, BCN or naviHealth via the appropriate prior authorization process.
Additional information
For more information, see the document titled Post-acute care: For skilled nursing, rehabilitation and long-term acute care facilities (PDF).
Thank you for your continued efforts to keep Michigan healthy and safe.
Posted: December 2021
Lines of business: Blue Cross Blue Shield of Michigan and Blue Care Network