Prior Authorization Updates for Skilled Nursing Facilities
At CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. (collectively, “CareFirst”), we are committed to continuous process improvement to enhance member and provider experiences.
Effective immediately, we have implemented a new process for the medical necessity review of skilled nursing facility authorization requests.
What changed?
The previous process for inpatient skilled nursing facilities provided approval for 14 days after verifying member benefits and medical necessity.
For the new process, authorization requests for covered members will auto-approve for five days. On day six of the stay, the Utilization Management team will review medical necessity for continued stay.
This change is expected to allow for faster decisions on these requests, so patients are receiving care at the right time and place.
If you have questions, please contact 1-866-PRE-AUTH (733-2884), option 1.