Know how to avoid SNF denials for Medicare Advantage claims

In November 2020, Blue Cross Blue Shield of Michigan and Blue Care Network will begin denying skilled nursing facility claims when patient-driven payment model, or PDPM, levels don’t match the levels naviHealth authorized. This applies to SNF claims for Medicare Plus Blue℠  and BCN Advantage℠ members.

Facilities can resubmit denied claims with the approved PDPM levels. In future communications, we’ll let you know the exact date on which we’ll begin denying claims.

As a reminder, naviHealth:

• Authorizes PDPM levels during the patient’s SNF stay (from preservice through discharge) for dates of service on or after Oct. 1, 2019.
• Works with SNFs to ensure billers submit proper PDPM levels for reimbursement.

For more information, see Post-acute care services: Frequently asked questions for providers.