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Timely notification for acute rehabilitation centers and skilled nursing facilities

 

To ensure that our members receive appropriate care in an acute rehabilitation center or a skilled nursing facility, effective March 1, 2020 our concurrent review nurses will request clinical information in order to secure an admission or a continued stay for a Medicare member.

 

When clinical information is requested, it’s important that you submit the requested information within two calendar days of the request. If we do not receive the requested information within this time frame, coverage for the days will be denied administratively for lack of precertification. If the member is in an approved facility and a continued stay review is requested but no clinical information is received, we’ll deny uncovered days administratively.