Updated guidance on prior authorization requirements for admissions to in-network long-term acute care hospitals (LTACHs)*
*Material Adverse Change (MAC)
This information applies to Anthem Blue Cross and Blue Shield Local Commercial health plans in Indiana, Kentucky, Missouri, Ohio and Wisconsin.
Anthem has updated guidance on prior authorization requirements for admissions to an in-network long-term acute care hospital (LTACH).
Effective April 18, 2022, we allow a 7-day initial length of stay upon notification of an admission to an in-network LTACH for members in Indiana, Kentucky, Missouri, Ohio and Wisconsin.
This process applies to transfers from hospital inpatient to LTACH ONLY.
It does not apply to transfers from acute in-patient rehab, LTACH to LTACH, skilled nursing facility (SNF) to LTACH, or out-of-network LTAC facilities.
This process to will remain in place until further notice.
- Facility and physician must be in-network for the member.
- Anthem requires notification of the LTACH 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 the initial 7-day length of stay without the need to provide clinical information.
- LTACH providers 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 LTACH, and then allow providers 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 8 of the LTACH stay.
- Anthem may apply monetary penalties, such as a reduction in payment, for failure to provide timely notice of admission.
June 2022 Anthem Provider News - Wisconsin