Behavioral Health Medicare Advantage Concurrent Review
March 21, 2025
Effective May 1, 2025, requests for Medicare Advantage Behavioral Health concurrent review for additional inpatient days will be reviewed utilizing the Centers for Medicare & Medicaid Services (CMS) Medicare Coverage Database.
Moreover, an additional source that Behavioral Health Episodic Case Managers will use for medical necessity beginning May 1 is the Milliman Care Guidelines.
The determination for the additional inpatient days will be made based on the Medicare necessity criteria, which can be found on the CMS website.
For questions regarding this change, email BehavioralHealth@bcbsnc.com.