Continuation of skilled nursing facility (SNF) process in Indiana and Ohio

Please note that the following information only applies to Anthem Indiana and Ohio local Commercial health plans.

 

You were previously notified that effective November 16, 2020 Anthem would allow a 5-day initial length of stay upon notification of an admission to an in-network SNF facility for Indiana and Ohio members.

 

This pilot was to end on June 1, 2021. It has been decided to continue this process until further notice.

 

This process applies to hospital inpatient transfers to skilled nursing facility (SNF) ONLY.

This does not apply to transfers from Acute IP Rehab, LTAC to SNF, or SNF to SNF

 

• Facility and physician must be in-network for the member.
• Anthem will require notification of the SNF admission, which includes sending demographics and verification of benefits, via the usual channels to aid in our members’ care coordination and management.
• Anthem will approve an ‘initial’ 5-day length of stay without the need to provide clinical information.
• SNF providers will need to submit the clinical information within two business days after the admission to aid in our members’ care coordination, discharge planning and member management. Note that prior authorization is still required but we allow the transfer to SNF, and then allow provider to send clinical within 2-days after the admission and prior to the last covered day for concurrent review.
• Concurrent review will be required starting on day 5 of the SNF stay.
• Anthem may apply monetary penalties such as a reduction in payment, for failure to provide timely notice of admission.

 

Indiana and Ohio will continue this process until further notice. We may conduct random audits and monitor trends to evaluate the effectiveness.

 

*Note: This process does not apply to admissions to out-of-network SNF facilities.

 

To view medical policies and utilization management guidelines applicable to members enrolled in the Blue Cross and Blue Shield Service Benefit Plan (commonly referred to as the Federal Employee Program_® (FEP_®)), please visit www.fepblue.org > Policies & Guidelines.

 

1167-0621-PN-IN.OH