Blue Medicare Authorization Reminders for North Carolina Critical Access Hospitals

Earlier this year, Blue Cross and Blue Shield of North Carolina (Blue Cross NC) provided communication to our valued Critical Access Hospital (CAH) partners regarding our Medicare Advantage (MA) initiative to perform earlier concurrent review to assist with discharge planning and transition of members to the next appropriate level of care as soon as identified.

As a reminder, at the time of ordering an inpatient admission, the Centers for Medicare and Medicaid Services (CMS) requires the admitting physician to certify the expectation that the member will be discharged or transferred to another hospital within ninety-six (96) hours. However, we have identified inpatient admissions with a higher-than-expected length of stay (LOS) at a CAH, often exceeding ninety-six (96) hours and extending up to fifteen (15) days in some instances.

We would like to take this opportunity to remind our CAH partners of the services that our Blue Cross NC utilization management (UM) and care management (CM) teams can provide. Specifically, these teams are available to coordinate with you early in the admission to assist with any discharge planning needs or arrangement of transfers to higher acuity facilities if the member’s condition will likely require continued admission beyond ninety-six (96) hours.

We appreciate your partnership in this process as we aim to serve our members together. If you have any questions, please contact customer service at 800-214-4844.