Update: Temporary Prior Authorization deferrals for members impacted by Hurricane Helene

Update – October 29, 2024: Blue Cross and Blue Shield of North Carolina (Blue Cross NC) is extending prior authorization deferrals for all acute inpatient admissions and emergency services in response to Hurricane Helene through November 29, 2024. Blue Cross NC will continue to re-evaluate as necessary. 

This temporary extension applies to Fully Insured plans, Administrative Services Only (ASO) plans (that have not opted out of such exceptions), State Health Plan (SHP), and Medicare Advantage plans, including Experience Health. For Federal Employee Program (FEP) members, follow the normal process related to the requested service(s). 

Please note that this temporary change also applies to any Blue Cross NC utilization management vendor. 

Blue Cross and Blue Shield of North Carolina (Blue Cross NC) is deeply concerned about our members and communities in Western North Carolina and other impacted states after the devastation of Hurricane Helene and is taking action.

To provide immediate relief, we have taken steps to help customers access the care they need. Blue Cross NC is deferring Prior Authorization for all acute inpatient admissions and emergency services. While this deferral policy is in place, providers can render services before obtaining authorization and such services will not be denied for failure to obtain prior authorization. Blue Cross NC will facilitate authorization retrospectively before the claim is filed.

While this deferral policy is in place, instead of obtaining Prior Authorization prior to providing the below service(s), Blue Cross NC is requiring providers to notify us of the below services as outlined to ensure that claims process correctly. Providers shall make such notification to Blue Cross NC prior to claims submission. 

This temporary change became effective September 25 and will remain in effect for 30 days. Blue Cross NC will re-evaluate as necessary. 

See below for additional clarifying details:

• This temporary deferral policy will only apply for members discharging/transferring from the inpatient level of care, observation or emergency department.
• A direct admission from home to a Skilled Nursing Facility/Unit (SNF) requires a full medical necessity review.
• Medical necessity review is required for length-of-stays extended beyond the days allowed on the initial notification/approval.
• Benefits will be verified at the time of provider notification of the service.

SNFs/Rehabilitation Facilities (Rehab):

• Commercial: For SNF/Rehab, initial approval will be authorized for seven (7) days, after which time, an additional review will be required.

Medicare Advantage:

• SNF: Initial approval will be authorized based on the existing process by Home & Community Care Transitions (formerly naviHealth). Concurrent review will be required to assess for continued length-of-stays extended beyond the initial days authorized.
• Rehab: Initial approval will be authorized by the Plan based on existing process.

Residential Services (MH/SUD):

• Residential Services: Initial approval will be authorized for 21 days. After which time, an additional review will be required.

This deferral policy applies to Fully Insured plans, Administrative Services Only (ASO) plans, State Health Plan (SHP), and Medicare Advantage plans, including Experience Health. For Federal Employee Program (FEP) members, follow the normal process related to the requested service(s).

Note that this deferral policy only applies to Blue Cross NC members receiving care in North Carolina and impacted surrounding areas only. It does not apply to Blue Cross NC members receiving care in areas not impacted by Hurricane Helene. It also does not apply to InterPlan Program (IPP) members receiving care in North Carolina.