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March 2013

Behavioral health admission, discharge notification processes change

Blues-designated facilities have new patient aftercare requirements

Research by the American Journal of Medical Quality shows that "in the absence of timely post-discharge care, patients are 1.5 to 3 times more likely to be re-hospitalized."1

To reduce patient readmissions, Blue Cross Blue Shield of Michigan now requires aftercare appointments to be scheduled within seven days of the patient’s discharge. This is now indicated on the Facility Admission and Discharge Notification Form.

Blues-designated facilities are also required to help members with patient appointment scheduling and reminders. We ask that outpatient follow-up is made by calling the patient one to two days after discharge to remind the patient of the appointment, assess if there are any barriers to keeping the appointment and assist if barriers do exist.

In addition to supporting more effective patient recoveries, taking these steps can also lead to a reduction in facility and insurer costs, as well as resource use.

Magellan is facilitating post-discharge appointment compliance for Blue Choice PPO and Federal Employee Program members.

1M.J. Orlosky, et al. Improvement of Psychiatric Ambulatory Follow Up Care by Use of Care Coordinators. American Journal of Medical Quality. 22 (2007): 95-97

Blue Cross Blue Shield of Michigan is enhancing its processes and forms for admitting and discharging members seeking behavioral health services.

Magellan Behavioral of Michigan Inc. manages the Blue Cross review process for psychiatric inpatient and partial hospitalizations and hospital-based substance abuse admissions. The authorization process is detailed below.

These changes impact Blues members with Blue Traditional® or PPO coverage. They do not apply to customer groups that have chosen a third party to administer their behavioral health benefits. In addition, select Blue Choice PPOSM and Federal Employee Program® members are exempt from the faxing process and will continue to require precertification or recertification by telephone for admissions that require authorization. Precertification is not required for partial hospitalization for FEP members.

Changes effective April 1, 2013
We have enhanced the Facility Admission and Discharge Notification Form and Case Management Referral Form.

As of April 1, 2013, the new form must be used. After April 1, previous versions of the form will not be accepted. Copies of the form are being mailed to facility utilization review directors.

We have also changed how and when the two forms are used.

Facility Admission and Discharge Notification Form
Both Blues-designated and nondesignated facilities are required to use this form for patient admissions and discharges.

  • Designated facilities must submit the form to Magellan within 24 hours of a patient discharge. The form must be faxed to Magellan at 1-888-656-1132.
  • Nondesignated facilities must follow these guidelines:
    • Submit the form to Magellan within 24 hours of an admission. The form must be faxed to Magellan at
      1-888-656-1132.
    • When a patient’s hospital stay is four days or fewer, the facility must fax the dischargeinformation to Magellan on the Facility Admission and Discharge Notification Form within 24 hours of discharge.
    • If the length of stay exceeds four days, the facility is required to call Magellan on day five of the admission for a concurrent review.
    • Facilities must also now submit the form to Magellan within 24 hours of a discharge for admissions that require review by telephone.

Case Management Referral Form

  • The Case Management Referral Form has been redesigned to align with the Facility Admission and Discharge Notification Form.
  • The Blues request that all facilities screen each admission for case management referrals, using the triggers listed on the Case Management Referral Form.

You will be able to access both forms online on web-DENIS starting April 1. They should be submitted to Magellan Behavioral of Michigan once completed. The forms include submission instructions.

To download the forms:

  1. Log in to web-DENIS.
  2. In the left-hand navigation, click on BCBSM Provider Publications and Resources.
  3. Click on Newsletters & Resources.
  4. Under “Other Resources,” click on Clinical Criteria & Resources.
  5. In the right-hand column under “Frequently Used Forms,” click on the Facility Admission and Discharge Notification Form or Individual Case Management Referral Form.

If you do not receive the new forms or you have other questions about behavioral health admissions, call Magellan
at 1-800-762-2382.

No portion of this publication may be copied without the express written permission of Blue Cross Blue Shield of Michigan, except that BCBSM participating health care providers may make copies for their personal use. In no event may any portion of this publication be copied or reprinted and used for commercial purposes by any party other than BCBSM.

*CPT codes, descriptions and two-digit numeric modifiers only are copyright 2012 American Medical Association. All rights reserved.
Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and
independent licensees of the Blue Cross and Blue Shield Association.