Local rules for acute inpatient medical admissions won't change until March 1, 2022, for all members

The local rules for acute inpatient medical admissions of members with certain conditions won't change until March 1, 2022, for all Blue Cross Blue Shield of Michigan and Blue Care Network commercial and Medicare Advantage members. This means:

• For any member who has certain conditions and who is admitted on or after March 1, 2022, facilities should wait until the member has been in the hospital for two days and then submit the authorization request on the third day.
• Facilities must provide clinical documentation that demonstrates that the InterQual^® criteria have been met at the time the request is submitted.

For a fuller account of the Local Rules for inpatient acute medical admissions of members with certain conditions admitted on or after March 1, including a list of those conditions, refer to the document Submitting acute inpatient authorization requests: Frequently asked questions for providers (PDF). In the table of contents, click What are the local rules that apply to members with certain conditions?

This is an update of earlier communications, in which we had said that this change in Local Rules would go into effect for Medicare Plus Blue^SM and BCN Advantage^SM members with certain conditions admitted on or after Jan. 3, 2022; and for BCN commercial members with certain conditions admitted on or after Feb. 1, 2022.

In addition, as a clarification, the Local Rules provide instructions only on when to submit the authorization request. They don't direct providers about writing admission orders (observation vs. inpatient) or about determining the level of care for the member.

We'll publish articles about this change in later issues of The Record and BCN Provider News.

Posted: December 2021
Lines of business: Blue Cross Blue Shield of Michigan and Blue Care Network