Prior Plan Approval
Admissions and private duty nursing
Services requiring prior plan approval:
- Inpatient admissions – Nonemergency, elective or scheduled admissions
- Private duty nursing
- Skilled nursing facility and acute rehabilitation admissions
- Transplants – solid organ or bone marrow/stem cell
Prior plan approval policies and procedures:
- BCBSNC should be notified of emergency admissions by the second business day of the admission.
- Maternity admissions related to delivery do not require preadmission certification for the first 48 hours for vaginal delivery or the first 96 hours for C-section. Inpatient stays beyond the first 48 hours for vaginal delivery or the first 96 hours for C-section require authorization.
- Any other elective/scheduled admissions must be approved prior to admission.
Policies apply to members covered by:
Blue Advantage®, Blue Care®, Blue OptionsSM and Classic Blue®.
Request prior plan approval:
For admissions and private duty nursing:
- By fax: Request form
- By phone: BCBSNC Utilization Management - 1-800-672-7897
Monday - Friday, 8 a.m. - 5 p.m., Eastern time
After hours, you may leave a voice message.