Follow-Up Visit to Be Scheduled Within 7 Days After Inpatient Mental Health or Substance Abuse Stays
Blue Cross and Blue Shield of North Carolina (BCBSNC) delegates the administration of mental health services and substance abuse management (including certification, concurrent review, discharge planning, and case management) to Magellan Health Services.
BCBSNC and Magellan are committed to providing the best care possible to our members. An integral part of this commitment is working with facilities to ensure that members discharged from an inpatient level of care should have a scheduled aftercare appointment with a mental health provider within seven days of discharge as part of aftercare compliance and to prevent readmissions. With this shared goal in mind, we would like to remind you of the importance of ensuring that our members receive timely ambulatory follow-up appointments after hospitalization from an acute care setting.
Tips to Ensure Successful Follow-Up Care After Hospitalization
- Discharge planning is expected to begin on the day of admission and should include the utilization review staff, discharge planner, the member’s family (at discretion of the member), significant others, guardian, or others as desired by the member.
- Admitting facility should ensure that discharged members have scheduled, verifiable follow-up appointments (not walk-in appointments) with a behavioral health provider or psychiatrist within seven days of discharge from an acute inpatient setting.
- A weekend discharge should not be a barrier for making sure the aftercare appointments are in place at the time of discharge.
- Magellan can provide you with a list of outpatient behavioral health network providers or psychiatrists, and they will assist you with any scheduling challenges before the member is discharged, if needed.
- An aftercare appointment with the member’s primary care physician should not be the only appointment in place upon the member’s discharge from an inpatient level of care.
- Discharging the member solely to a group home, assisted living facility, Alcoholics Anonymous, or Narcotics Anonymous is not an appropriate discharge plan.
- A member should not be discharged from a facility with instructions to set their own follow-up appointment. Either assist the member in contacting the provider of choice by having them contact the provider and make the appointment while still inpatient, or see assistance from Magellan to schedule the follow-up appointment before the member is discharged.
- Explain the benefits of aftercare to the member, so he or she understands the importance of keeping these follow-up appointments.
- Verify with the member that the aftercare plan is a good fit for him or her (e.g., transportation is not problematic, time of the appointment will work, etc.).
- Involve and educate the member’s family to support the aftercare plan.
- Explain to the member the importance of staying on medication and notifying the prescribing physician of any side effects.
Important Billing Information: Please remember to submit all claims to BCBSNC as soon as possible. This enables us to reconcile with the National Committee for Quality Assurance (NCQA) and other entities for timely reporting.
Thank you for your cooperation, which enables us to comply with NCQA requirements, as well as helps ensure that our members receive the service they need when they need it. If you have any questions, please call the Provider Blue LineSM at 1.800.214.4844.