Transfer Medicare Advantage members to post-acute care facilities immediately after appeals are approved

When you submit an expedited appeal to Blue Cross Blue Shield of Michigan or Blue Care Network, we have 72 hours to approve or deny the appeal. Within those 72 hours, we’ll send a fax to inform you of our determination. Once you receive a fax from us stating that an appeal has been approved, you can immediately transfer the member to a post-acute care facility.

Although naviHealth will provide an authorization number later, don’t wait for that number to transfer the patient. The fax you received serves as proof of the approval.

Post-acute care providers should accept the transfer based on the faxed notification stating that we approved the appeal.

If you’d like a status update on an appeal request, call us at:

• For Medicare Plus Blue℠ members: 1-866-309-1719
• For BCN Advantage℠ members:
• Facility providers: 1-800-249-5103
• Professional providers: 1-800-344-8525

How to submit an appeal to get the fastest response

For the fastest response to your appeal request:

1. Fax it to the fax number listed on the denial letter.

If you don’t have a copy of the denial letter, you can request a copy from naviHealth by calling 1-855-851-0843 or by submitting a request through nH Access.

2. On the fax cover sheet, be sure to indicate that you’re requesting an expedited appeal.

For your convenience, the fax numbers for submitting appeals are:

• For Medicare Plus Blue members: Fax to 1-877-348-2251.
• For BCN Advantage members: Fax to 1-866-522-7345.

Reminder

As a reminder, the Medicare Plus Blue and BCN Advantage Grievance and Appeals units handle requests to appeal denials of post-acute care services for both prior authorization requests and retroactive authorization requests.

Additional information

For additional information about post-acute care services for Medicare Advantage members, see the Post-acute care services: Frequently asked questions for providers document.

naviHealth Inc. is an independent company that manages authorizations for post-acute care services for Blue Cross Blue Shield of Michigan and Blue Care Network members who have Medicare Advantage plans.