Reminder: Complete clinical documentation required for Skilled Nursing Facilities requests

Blue Cross and Blue Shield of North Carolina (Blue Cross NC) is sharing an important reminder for Skilled Nursing Facilities (SNF).

To support timely reviews and avoid delays in care, complete and relevant clinical documentation should be included with all requests for SNF admission and continued stay. When a request is not approved, this is an indicator that either the medical necessity criteria were not met or that the clinical materials submitted for approval were not complete.

It is imperative for requesting providers to submit all required clinical materials at the time of any SNF request or when submitting an Appeal to ensure the health care needs of members are managed expeditiously and to reduce disruptions in care.

For questions about the relevant clinical materials required for these requests, please contact Home & Community Care Transitions (formerly known as naviHealth) for support at 844-801-3686, Monday through Friday, 8:00 AM to 5:00 PM ET.