Prior authorization requests for commercial SNF admissions will need to be submitted through e‑referral system

Beginning Jan. 1, 2022, we’ll require skilled nursing facilities to submit prior authorization requests through the e-referral system and not by fax. This applies to requests for our Blue Cross Blue Shield of Michigan and Blue Care Network commercial members for:

• Initial admissions
• Additional days

In September 2020, we encouraged SNF providers to submit commercial prior authorization requests through the e‑referral system starting Dec. 1, 2020. Many SNFs have begun doing that but others are still faxing the requests.

What’s changing

Starting Jan. 1:

• We’ll stop accepting faxed requests as a general practice.
• We’ll accept faxes only for urgent requests when the e-referral system isn’t available. In those instances, fax the form using the instructions on the document titled e-referral system planned downtimes and what to do.

If we receive a faxed form for a non-urgent admission when the e-referral system is available, we won’t accept the request. We’ll notify you by fax or phone that you must submit the request through the e-referral system.

Sign up now to use e-referral system

To prepare for this change, it’s important that SNFs sign up now for access to the e-referral system. Don’t wait to sign up, as it may take some time to get access.

You’ll also need to learn how to use the e-referral system so you’re comfortable with it when this change goes into effect.

Everything you need to know is on our ereferrals.bcbsm.com website:

• To sign up for the e-referral system: Follow the instructions on the Sign up for e-referral or change a user page.
• To learn how to use the e-referral system, refer to the Training Tools page, where you’ll find the e-referral User Guide and Online Self-paced Learning Modules. On the Training Tools page, scroll down to the e-referral Overview for Skilled Nursing Facilities presentation heading and access these resources:
• Recorded webinar
• Presentation slides (PDF)

Do’s and don’ts when submitting through the e-referral system

For tips on how to make it easier to use the e-referral system when submitting commercial SNF prior authorization requests, refer to the article we published in the May 2021 issue of The Record titled “Do’s and don’ts when submitting commercial SNF requests using the e‑referral system.”

Earlier communications about this change

In 2020, we communicated about submitting these requests through the e-referral system through these articles:

• “Skilled nursing facilities to follow new process to submit authorization requests for Blue Cross, BCN commercial members,” in the September 2020 issue of The Record
• “Commercial SNF authorization requests to be submitted through the e-referral system starting later this year,” on Page 36 of the September-October 2020 issue of BCN Provider News

In these articles, we encouraged SNF providers to sign up for and start using the e‑referral system while faxing was still an option.

We also communicated about this through a web-DENIS message and a news item on our ereferrals.bcbsm.com website. 

As a reminder, naviHealth is an independent company that manages prior authorization requests for SNF admissions for our Medicare Plus Blue℠ and BCN Advantage℠ members.