Hospitals must notify naviHealth before transferring Medicare Advantage members to SNFs

As communicated previously, we waived the requirement to obtain clinical review for the first three days of skilled nursing facility stays for Medicare Plus Blue^SM PPO and BCN Advantage^SM members transferred from acute care hospitals. This is in effect for transfers that take place from April 3 through May 31, 2020.

Hospitals are still obligated to notify naviHealth about transfers.

However, we're finding that some hospitals are transferring our Medicare Advantage members to SNFs without notifying naviHealth.

To avoid problems, we're clarifying what you need to do:

• Notify naviHealth by submitting an authorization request but not attaching clinical documentation. You can do this through:
  • CarePort Care Management (formerly known as Allscripts^®)
  • nH Access^™, the naviHealth provider portal
  • Calling 1-855-851-0843
  • Faxing to 1-844-899-3730
• Submit the following information to naviHealth with your notification:
  • Name and contact information for person notifying the plan
  • Patient demographics (name, date of birth, enrollee ID, etc.)
  • Name of ordering physician
  • Patient diagnosis
  • Name of accepting SNF

  Note: If you need assistance locating a SNF, include a request for assistance when you submit notification to naviHealth. They'll have their clinicians reach out to local facilities.

We're asking SNFs to confirm that naviHealth has received the required notification for each member before they accept the transfer. Once naviHealth receives the notification, they'll provide a three-day authorization to transfer the patient to the SNF.

Failure to notify naviHealth means there's no authorization in our system when we receive the claim from the SNF.

We'll update the COVID-19 utilization management changes document with the details about the information you must send when notifying naviHealth.

Posted: April 2020
Lines of business: Blue Cross Blue Shield of Michigan and Blue Care Network