Blue Cross | Blue Shield | Blue Care Network of Michigan The Record

Stethoscope with RX papers

Forward to a friend  |  Subscribe  |  The Record Archive  |  Contacts  |  |  Print this article

June 2019

Update: naviHealth managing authorizations for MA members moving to post-acute care facilities

A few training sessions remain for health care providers to learn more about naviHealth’s clinical model and provider portal.

As you read in a May Record article, naviHealth will be managing authorizations for Medicare Plus BlueSM PPO and BCN AdvantageSM members who are moving into skilled nursing, long-term acute care and inpatient rehabilitation facilities. The transition to naviHealth is effective for authorization requests submitted for admission dates on or after June 1, 2019, for both in-state and out-of-state cases.

Following is the schedule for remaining webinar dates and times. Click here to register.

Acute care hospitals Wednesday, June 5, 8 to 9:30 a.m.
Skilled nursing facilities Wednesday, June 5, 11:30 a.m. to 1:30 p.m.
Inpatient rehabilitation facilities and long-term acute care hospitals Thursday, June 6, 11:30 a.m. to 1 p.m.

Here’s some additional information to keep in mind:

  • Post-acute care facilities should always check to see if an authorization is in place when they’re handling an admission for a Medicare Advantage patient. If an authorization wasn’t submitted by the acute care facility, then the post-acute care facility should submit the authorization request.
  • Retrospective authorizations can be submitted electronically up to 90 days post-discharge from an acute care facility. Beyond 90 days, authorizations must be phoned in or faxed.

For more details on how to submit authorization requests, see the May Record article.

To access an FAQ on post-acute care services, click here.

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 2018 American Medical Association. All rights reserved.