Please note that the following information applies to Anthem Blue Cross and Blue Shield (Anthem) local Commercial health plans in Wisconsin.

 

In the April 2021 edition of Provider News, we announced that effective March 1, 2021, Anthem would allow a five-day initial length of stay upon notification of an admission to an in-network SNF facility for members in local Commercial plans.

 

This pilot was to end on June 1, 2021. After reviewing the outcomes of the pilot period, we have decided to reinstitute the program as of August 1, 2021.

 

Reminders regarding the program:

  • This program applies to hospital inpatient transfers to skilled nursing facility (SNF) only.
  • This program does not apply to:
    • Transfers from Acute IP Rehab, LTAC to SNF, or SNF to SNF
    • Admissions to out-of-network SNF facilities
  • 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 five-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 two days after the admission and prior to the last covered day for concurrent review.
  • Concurrent review will be required starting on day five of the SNF stay.
  • Anthem may apply monetary penalties such as a reduction in payment, for failure to provide timely notice of admission.
  • We will continue this process until December 31, 2021. We may conduct random audits and monitor trends to evaluate the effectiveness.

 

Members in the Blue Cross and Blue Shield Service Benefit Plan (commonly referred to as the Federal Employee Program® (FEP®)) are excluded from this program. To view medical policies and utilization management guidelines applicable to members enrolled in FEP®, please visit fepblue.org > Policies & Guidelines. 

 

1319-1021-PN-WI



Featured In:
October 2021 Anthem Provider News - Wisconsin