April 1, 2020
BCBSNM Waiving Prior Authorization for Transfers to Post-acute Facilities
Blue Cross and Blue Shield of New Mexico (BCBSNM) is waiving prior authorization requirements for transfers to in-network, medically necessary alternative post-acute facilities until April 30, 2020.
We will no longer require prior authorization to transfer our members from an inpatient hospital to an in-network medically appropriate, post-acute site of care such as long-term acute care hospitals and skilled nursing facilities.
This will help promote availability of acute care capacity for COVID-19 patients during this public health emergency. It also allows our members to continue to access medically necessary care.
If the transfer is for a behavioral health facility, it will require prior authorization.
Which members will benefit? This applies to the following members:
What does this mean?
Providers can transfer our members to the safest, medically necessary in-network site of care as soon as it is medically appropriate. Providers do not need prior authorization approval to transfer our members to a post-acute care facility that is:
How long will BCBSNM not require prior authorization for these transfers?
BCBSNM will not require prior authorization for transfers from an inpatient hospital to an alternative post-acute setting until April 30, 2020. BCBSNM will continue to evaluate if the timeframe needs to be extended to best serve our members.