Blue Medicare Authorization Changes for North Carolina Critical Access Hospitals

Blue Cross and Blue Shield of North Carolina (Blue Cross NC) recognizes the important front-line role that Critical Access Hospitals provide to our members. As a valued provider who is also committed to making sure our members receive quality care, we ask for your partnership as we take a more proactive approach to Transition of Care planning.  

For Medicare Advantage, Blue Cross NC will begin to perform concurrent review on an earlier and more frequent basis to support our Critical Access Hospitals and our members with their transitions of care beginning June 1, 2023. 

Our goal is to collaborate with providers to identify members in need of additional discharge planning support and be ready to assist with transitioning the member to the next appropriate level of care as soon as medically appropriate.

• This enhancement will help:
  • More effectively manage members' transition-of-care phases.
  • Develop strategies to reduce members' length of stay.
• For facilities that provide electronic medical record (EMR) access, we will communicate regularly with your UM team to discuss goals and barriers.
• For facilities that do not offer EMR access, Blue Cross NC UM staff will reach out for updated clinical records. We appreciate your prompt response via phone or fax.