This article is for skilled nursing facilities and rehabilitation hospitals caring for our members
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:
The authorization waiver does not apply to:
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.
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 |
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 |
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.
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