March 29, 2024 reminder: This temporary waiver will end on April 1, 2024.
To: Skilled nursing facilities and rehabilitation hospitals caring for our members
As we did in early 2023, we will again temporarily waive authorization requirements for patient transfers from acute care hospitals to help skilled nursing facilities (SNFs) and acute rehabilitation hospitals manage an influx of inpatient admission requests. This relaxation of authorization requirements will last from January 8, 2024 through April 1, 2024.
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 (FEP) 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.
- BlueCard members (members of another Blue Plan receiving care in Massachusetts).
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
- All providers are now required to submit initial authorization requests and inquiries electronically through Authorization Manager rather than by phone or fax for our commercial (HMO, PPO) and Federal Employee Program (FEP) members.
- Authorization Manager is available 24/7 at no additional cost via single sign-on through Provider Central. 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.
- Authorization Manager is available 24/7 at no additional cost via single sign-on through Provider Central. Go to the Authorization Manager page 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.
- If you haven’t used Authorization Manager and would like to learn more, please email our support team at hmmauthorizationmanager@bcbsma.com.
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
- Recertification Form for SNF/Rehab/LTCH
- Authorization Manager guide for Skilled Nursing Facilities, Rehab and LTCH
- Authorization Manager: Skilled Nursing Facility, Rehab and LTCH Authorization Request Demo Video (3 min)
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