Temporary Transfer Authorization Requirements
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Temporary suspension of prior authorization for transfers from acute inpatient settings to LTACH, SNF, or inpatient rehabilitation for Blue Cross and Blue Shield of Louisiana (and HMO Louisiana, Inc.) members, with notification and concurrent review requirements; excludes Blue Advantage HMO and PPO members.
No material clinical or coverage changes in this revision.
Temporary Transfer Authorization Criteria
Temporary Transfer Authorization Criteria
Covered when ALL of the following temporary provisions are met:
Authorization and review process
- The receiving facility must notify Blue Cross of the admission within 24 hours.
- Blue Cross will automatically approve a 3-day stay for the receiving facility upon notification.3 days
- Blue Cross will perform a concurrent review by day 4 to determine and authorize any continued stay based on medical necessity of the continued treatment of the underlying condition.
Exclusion - benefits and prior auth suspension do not apply to Blue Advantage plans.
Coding & Quick Values
| No codes listed |
Provider Notification & Prior Authorization Suspension
Temporary suspension of prior authorization for transfers (acute inpatient → LTACH/SNF/inpatient rehab)
For all acute inpatient admission transfers on or after August 9, 2021, Blue Cross is suspending the requirement to obtain prior authorization to move patients from an acute care inpatient setting to a LTACH, SNF, or inpatient rehabilitation facility. The receiving facility must notify Blue Cross of the admission within 24 hours; Blue Cross will automatically approve a 3-day stay and perform a concurrent review by day 4 to authorize continued stay based on medical necessity.
- Suspension applies to transfers from acute inpatient to LTACH, SNF, or inpatient rehabilitation for dates of service on and after August 9, 2021.
- Receiving facility must notify Blue Cross within 24 hours of admission.
- Blue Cross will automatically approve a 3-day stay upon notification.
- Concurrent review will be performed by day 4 to determine authorization of continued stay based on medical necessity.
Apply in‑network level benefits for specified inpatient transfers
Blue Cross will apply in‑network level benefits for all in‑state and out‑of‑state inpatient admission transfers for Blue Cross and Blue Shield of Louisiana and HMO Louisiana, Inc. members even if the receiving facility is not in the member's network; this provision does not apply to Blue Advantage HMO and Blue Advantage PPO members.
- Applies to BCBSLA and HMO Louisiana, Inc. members for inpatient admission transfers.
- In‑network level benefits apply regardless of the receiving facility's network status.
- Exclusion: Blue Advantage HMO and Blue Advantage PPO members are not covered by this change.
Key Terms & Exclusions
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