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Notice to participating skilled nursing facilities (SNFs)

When a Notice of Medicare Non-Coverage (NOMNC) is issued notifying you of the last covered day of skilled services, the NOMNC must be delivered to the Medicare Advantage member for signature by the end of regular business hours that day, seven days per week (i.e., 8:00 a.m. to 5:00 p.m.).

If received after regular business hours, it must be delivered by the end of business hours the following day, seven days per week.

Clinical documentation that we request for SNF Continued Stay review includes:

  • PT/OT/SLP notes (three to five days), including any cognitive testing completed and any therapy minutes or logs
  • New orders and new MD/NP notes
  • Nurses notes for the previous three to five days
  • If IV meds, the stop date; if wounds, wound treatments/notes
  • Social Services notes with updated Anticipated DC plan with estimated length of stay
  • Any other information that demonstrates a skilled need for continued SNF (Medicare Benefits Policy Manual, Chapter 8, Section 30)

For continuing stay reviews, it’s important to provide requested clinical information that’s current (e.g., progress notes from within the most recent 48 hours).

The preferred, most efficient way to provide clinical information to us is electronically, via NaviNet.

If there is a delay in presenting a NOMNC to our member or if requested clinical information is not provided in a timely manner, coverage for additional days of service will be denied and not reimbursed. The member will be held harmless in accordance with your agreement with Aetna.