Relieving burden on our providers and members during this health crisis.
CMS is waiving the three night acute care stay requirement for SNF coverage due to the state of emergency declaration. Will Capital Blue Cross follow this guideline?
Capital Blue Cross does not require a three-night acute stay prior to a SNF admission for Medicare Advantage products.
Will Capital Blue Cross be adjusting the length of time a preauthorization is valid before it expires?
Yes. Authorizations issued prior to August 1, 2021:
- For services that may be delayed due to COVID-19, new preauthorizations will be valid for at least six months.
- For services that are likely to be impacted by the pandemic, such as: OP surgery, IP electives, DME etc., we have extended existing preauthorizations by six months.
If you experience a problem with preauthorization timeframes, please call the preauthorization line, and we can adjust end dates as needed.
Standard authorization requirements and durations will resume for all authorizations issued on August 1, 2021 and after.
How will other preauthorizations apply during the COVID-19 emergency?
Preauthorizations related to COVID-19 diagnostic tests:
- Covid-19 tests: no preauthorization is required
- Laboratory tests - CBC and electrolytes: no preauthorization is required
- Chest X-rays: no preauthorization is required
- CT scan chest: preauthorization is waived (effective July 1, 2021, preauthorization is required)
Prior to August 1, 2021, preauthorization will be waived for most services with diagnosis codes on the CDC COVID-19 recommended list. Exclusion include: medical specialty injectable, genetic testing, transplant, reconstructive/cosmetic surgeries, MSK and NIA.
The preauthorization portal will provide an auto-approval so providers may continue to receive authorization numbers; however, they are not required for COVID-19-related services.
Standard authorization requirements and durations will resume for all authorizations issued on August 1, 2021 and after.
