Update: Temporary suspension of clinical review requirements continues for admission to skilled nursing facilities from hospitals in certain states
We're updating an earlier news item to show that the temporary suspension of clinical review requirements does not apply to members covered through the Blue Cross and Blue Shield Federal Employee Program® who are transferred to SNFs in Michigan.
The temporary suspension of clinical review requirements for the first three days of admission to skilled nursing facilities from hospitals in certain states is still in effect.
When this temporary change ends, we'll notify you by posting a web-DENIS message in Provider Secured Services and a Provider Alert on bcbsm.com.
This temporary change is due to the COVID-19 pandemic and applies to all lines of business, including Blue Cross Blue Shield of Michigan commercial, Blue Care Network commercial, Medicare Plus BlueSM and BCN AdvantageSM.
Exception: This change does not apply to members covered through the Blue Cross and Blue Shield Federal Employee Program who are transferred to SNFs in Michigan. For these members, clinical review is required before the transfer takes place. In addition, to use their SNF benefit, these members must sign a consent for case management. All clinical information and the member's signed consent for case management must be faxed to 1-866-411-2573. Authorization requirements for Federal Employee Program members transferred to SNFs outside of Michigan are governed by the requirements of the state in which the SNF is located.
To view details about this temporary change, including a list of affected states, see this Provider Alert (PDF).
You can check the status of this and other temporary measures in the document titled Temporary changes due to the COVID-19 pandemic.
As a reminder, continue to notify Blue Cross, BCN or naviHealth via the appropriate prior authorization process when you transfer members to SNFs. Also, assistance is available for post-acute care placements; see this Provider Alert (PDF) for more information.
Posted: January 2022
Lines of business: Blue Cross Blue Shield of Michigan and Blue Care Network