Blue Cross and Blue Shield of North Carolina (Blue Cross NC) provides guidance on NaviHealth Prior Plan Approval
This is a reminder from Blue Cross and Blue Shield of North Carolina (Blue Cross NC) that Prior Plan Approval is required for all NaviHealth Skilled Nursing Facility (SNF) authorizations. Please note, any days not prior approved will not be authorized by NaviHealth. For more details, please review the frequently asked questions below.
NaviHealth SNF Frequently Asked Questions
Q. Is Prior Plan approval required for Skilled Nursing Facilities?
A. Yes, Prior Plan Approval is required for covered Skilled Nursing Facility admissions. Days that are not prior approved will not be authorized by NaviHealth.
Q. How do I request Prior Plan Approval?
A. To request prior approval, please contact NaviHealth representatives by phone or fax:
- By telephone: 844-801-3686, Monday through Friday, 8 AM to 5 PM ET.
- By fax: 855-847-7242. Use this NaviHealth Fax Cover Sheet to fax requests and clinical information to NaviHealth.
Q. When should Skilled Nursing Facility providers contact NaviHealth for an authorization?
A. Authorizations must be generated BEFORE a member is admitted to a Skilled Nursing Facility. If a transfer happens after normal business hours, the Skilled Nursing Facility must notify NaviHealth within 24 hours, or the next business day.
Q. Which services does NaviHealth authorize?
A. NaviHealth authorizes care delivered at a Skilled Nursing Facility, including the initial admission and continued stay requests. Additionally, they also issue the notification for the last covered day for the Skilled Nursing Facility to deliver care. NaviHealth manages the Blue Medicare℠ and Experience Health℠ Skilled Nursing Benefits.
Q. What happens if a request for a Skilled Nursing Facility admission is sent to Blue Cross NC instead of NaviHealth?
A. Providers should submit all Skilled Nursing Facility requests to NaviHealth. If a request is submitted to Blue Cross NC in error, the request will be forwarded to NaviHealth for review and processing. The provider does not need to resubmit the request to NaviHealth.