For commercial LTACH requests, questionnaire opens in e-referral system

When submitting a prior authorization request for an admission to a long-term acute care hospital, or LTACH, you must complete a questionnaire about the three skilled nursing facilities, or SNFs, you have contacted.

These must be SNFs you believe may be able to provide care for the member but that have indicated they can’t provide the level of care the member requires.

This applies to LTACH placement requests for most Blue Cross Blue Shield of Michigan and Blue Care Network commercial members.

You must provide the following information:

• Whether you’ve contacted three SNFs (yes or no)
• Name and contact information for each SNF

Follow the prompts in the questionnaire to ensure you’ve provided the information that’s required.

If the required information isn’t included when you submit the prior authorization request, the request is considered incomplete and can’t be processed. We’ll reach out to you and ask that you resubmit the request when the information is available. This delays the processing of the request.

Be aware that:

• The three SNFs must be contracted with Blue Cross or BCN and located within 75 miles of the facility in which the member is currently a patient.
• Two of the three SNFs must be facilities that can accommodate members who need higher levels of care such as complex wound care or total parenteral nutrition.

You can read more about these and other requirements in the document Blue Cross and BCN Local Rules for 2023 for post-acute care: Modifications of InterQual^® criteria.

You can access this document at ereferrals.bcbsm.com, on these webpages:

• Blue Cross Authorization Requirements & Criteria
• BCN Authorization Requirements & Criteria