Extension of Temporary Prior Authorization Waiver for Skilled Nursing Facilities and Residential Treatment Centers

Due to the spike in COVID-19 cases and hospitalizations, Blue Cross and Blue Shield of North Carolina (Blue Cross NC) is extending the temporary waiver of prior authorization requirements for all conditions, including non-COVID-19 conditions, and require notification only for covered services incurred at in-network skilled nursing facilities (SNFs) and residential treatment centers (RTCs).

Please see below for details:

• This temporary measure went into effect on Dec. 21, 2020, and will now expire on Feb. 21, 2021.
• This waiver only applies to services incurred at in-network SNFs or RTCs for members discharging from inpatient level of care. Medical necessity review is required for length-of-stay extensions beyond the days allowed on the initial approval.
• This measure applies to fully insured, self-funded employer groups (including State Health Plan) and all Medicare Advantage plans offered or administered by Blue Cross NC, including Experience Health. This does not apply to Federal Employee Program members.

Our Blue Cross NC teams are working to review all prior authorizations for post-acute care and inpatient hospital admissions as quickly as we can.