Prior Plan Review

Admissions and private duty nursing

Services requiring prior plan approval:

  • Inpatient admissions – Nonemergency, elective or scheduled admissions
  • Private duty nursing
  • Skilled nursing facility and acute rehabilitation admissions
  • Transplants – solid organ or bone marrow/stem cell
  • For State Health Plan only, intensive outpatient and partial hospitalization. Please contact Beacon Health at 800-367-6143.

Prior plan approval policies and procedures:

  • Blue Cross NC should be notified of emergency admissions by the second business day of the admission.
  • Maternity admissions related to delivery do not require preadmission certification for the first 48 hours for vaginal delivery or the first 96 hours for C-section. Inpatient stays beyond the first 48 hours for vaginal delivery or the first 96 hours for C-section require authorization.
  • Any other elective/scheduled admissions must be approved prior to admission.

Policies apply to members covered by:

Blue Advantage®, Blue Care®, Blue OptionsSM and Classic Blue®.

Request prior plan approval:

For admissions and private duty nursing:

  • By fax: Request form 

  • By phone: Blue Cross NC Utilization Management - 1-800-672-7897
    Monday - Friday, 8 a.m. - 5 p.m., Eastern time
    After hours, you may leave a voice message.