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October 2019

HMS concluded Medicare Plus Blue audits of skilled nursing facilities May 31

HMS®, an independent company that performs audits for Blue Cross Blue Shield of Michigan, stopped conducting skilled nursing facility audits for Medicare Plus BlueSM members after May 31, 2019, admissions.

As you read in the April Record article, authorizations for Medicare Plus Blue PPO members who require a transfer from acute inpatient hospitals to skilled nursing facilities are managed by naviHealth, an independent company that handles care transitions, effective June 1, 2019.

For more information on the prior authorization request process, see the Medicare Plus Blue PPO Manual.

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*CPT codes, descriptions and two-digit numeric modifiers only are copyright 2018 American Medical Association. All rights reserved.