Program delay announcement authorizations for post-acute care services for commercial members

In the April 2023 edition of the Provider News, we announced a new prior authorization program for Post-Acute Care (PAC) services administered by Carelon Post Acute Solutions, LLC* that was scheduled to begin on July 1, 2023. Please note that the implementation of this program has been delayed until September 1, 2023.

In the meantime, continue to contact Anthem Blue Cross and Blue Shield (Anthem) forprior authorization requests for admission to or concurrent stay in a skilled nursing facility (SNF), an inpatient acute rehab facility (IRF), or a long-term acute care hospital (LTACH).

As a reminder, with this program implementation on September 1, 2023, please note the following changes:

• Anthem will transition to Carelon Post Acute Solutions Care Clinical Appropriateness Guidelines. The guideline can be accessed here.
• The modified prior authorization requirements for admissions to in-network SNF providers (effective November 16, 2020, for OH and IN and 3/1/2021 for KY, MO, and WI) that allow a five-day initial length of stay upon notification of an admission to an in-network SNF facility will no longer apply.
• The modified prior authorization requirements for admissions to in-network LTACH providers (effective April 18, 2022) that allow a seven-day initial length of stay upon notification of an admission to an in-network LTACH will no longer apply.

If you have questions, please call the Carelon Post Acute Solutions Provider Call Center at 833-431-0780.