April 1, 2020
BCBSIL Waiving Prior Authorization for Transfers to Post-acute Facilities
Blue Cross and Blue Shield of Illinois (BCBSIL) 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:
- Fully insured
- Self-funded group
- Retail
- Medicare Advantage
- Medicaid (subject to approval by local regulators)
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:
- In-network consistent with the member’s plan (e.g., a PPO member could be transferred to an in-network PPO facility)
- Medically appropriate for the member and medically necessary
- Available and accepting transferred members
How long will BCBSIL not require prior authorization for these transfers?
BCBSIL will not require prior authorization for transfers from an inpatient hospital to an alternative post-acute setting until April 30, 2020. BCBSIL will continue to evaluate if the timeframe needs to be extended to best serve our members.
