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Reminder: Skilled Nursing Facility Benefits Only Available for Inpatient Care

Blue Cross and Blue Shield of North Carolina (BCBSNC) would like to remind all participating skilled nursing facilities (SNFs) that only inpatient SNF services are eligible for reimbursement per your contract with us. Outpatient SNF services are not eligible services under your contract and will be denied.

If you need additional information, please refer to section 9.50 of our online provider e-manual, the Blue BookSM, for details about skilled nursing billing and claims submission. This section states:

“Skilled nursing care is inpatient care, which must be furnished by or under the supervision of registered or licensed personnel and under the direction of a physician to assure the safety of the member and achieve the medically desired result. The member must require continuous (daily) skilled nursing services for the level of care to be considered covered.”

This section of the provider e-manual also states that the following services are not part of your skilled nursing facility contract with BCBSNC and must be billed by a provider who contracts with BCBSNC:

  • Medical care rendered by a physician
  • Services rendered in a place or setting other than the skilled nursing facility while the member is an inpatient

If you have any questions, please call the Provider Blue LineSM at 1.800.214.4844.