Change in inpatient status approval for elective procedures beginning February 1, 2026

Effective February 1, 2026, Blue Cross and Blue Shield of North Carolina (Blue Cross NC) Medicare Advantage and Dual Eligible Special Needs Plan (D-SNP) products will implement a change in how inpatient status is approved for elective procedures.

Under this new policy:

• Inpatient status will no longer be approved in advance for elective procedures.
• The level of care will be determined based on the member’s clinical condition following the procedure.

This change aligns with Centers for Medicare & Medicaid Services (CMS) guidelines and supports appropriate site-of-service utilization. Providers should continue to follow standard authorization processes for the procedure itself.

Additional guidance, including FAQs and documentation requirements, will be made available on Blue e in the coming weeks.

If you have questions or need further clarification, contact customer service at 888-296-9790.

Thank you for your continued partnership in delivering high-quality, cost-effective care to our members.