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Temporarily waiving auth requirements for SNFs, rehab hospitals
December 14, 2022

This article is for skilled nursing facilities and rehabilitation hospitals caring for our members

Update issued: March 8, 2023
We have extended the authorization requirements waiver outlined below through April 20, 2023 to help you continue to manage inpatient admissions.

To help skilled nursing facilities (SNFs) and acute rehabilitation hospitals manage an influx of inpatient admission requests, we’re temporarily waiving authorization requirements for patient transfers from acute care hospitals. This relaxation of authorization requirements will last for 90 days (from December 6, 2022 to March 6, 2023).

The authorization waiver does apply to:

  • Commercial HMO and PPO, Medicare Advantage, and Indemnity members.
  • In-network providers.
  • Massachusetts-based, out-of-network providers.

The authorization waiver does not apply to:

  • Federal Employee Program members; please follow your normal authorization submission process.
  • Long-term and custodial admissions.
  • Out-of-state, out-of-network providers; we’ll review these requests on an individual case basis.

Notify us of admissions

Skilled nursing and acute rehabilitation facilities are required to notify us of any admissions within 24 hours of admission. We will approve the first five days and thereafter, clinical documentation will be required to support continued skilled level of care at the facilities.

Notification requirements by service and product

Type of review Requirement for commercial HMO and PPO, Medicare Advantage, Indemnity Requirement for Federal Employee Program
Initial admission Notification only Medical necessity
Concurrent Medical necessity Medical necessity

Definitions

Notification only required Does not require submission of clinical documentation for initial admission
Medical necessity review required Requires that the requesting provider submit clinical documentation in support of the request

How to notify us

  • We prefer you submit notifications via Authorization Manager
  • If you’re unable to submit via Authorization Manager, you can notify us via the appropriate fax number on the form below in the Resources section.

How to access Authorization Manager

To access the Authorization Manager tool, you must be registered for our Provider Central website. Log into Provider Central, navigate to eTools>Authorization Manager, and click the "Go Now" button. If you don’t see a "Go Now" button, please contact the Provider Central account administrator in your office to give you access to this eTool.

Who can register for Provider Central?

  • Management or office staff at a provider practice or organization.
  • Billing agencies that work on behalf of a participating provider.

Resources

MPC_120722-1Z-1