Skilled and private nursing

• 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

• 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.

• Blue Advantage®
• Blue Care®
• Blue Options℠
• Classic Blue®

For admissions and private duty nursing

• By phone: Blue Cross NC Utilization Management - 800-672-7897
  • Monday through Friday, 8 AM to 5 PM ET
  • After hours, you may leave a voice message.

Skilled nursing facility admissions

For Blue Medicare HMO and Blue Medicare PPO, prior approval is required for covered skilled nursing facility admissions. To request prior approval, please contact Home & Community Care Transitions representatives:

• By telephone: 844-801-3686
  • Monday through Friday, 8 AM to 5 PM ET
• By fax: 855-847-7242
  • Use this Home & Community Care Transitions Fax Cover Sheet (PDF) to fax requests and clinical information to Home & Community Care Transitions.

To submit additional information via fax for a case that has already been authorized, use the following numbers:

• Concurrent Review: 844-206-7051 (fax)
• MDS, Administrative: 844-331-4502 (fax)

Find out more about Home & Community Care Transitions FAQ (PDF) at homeandcommunity.com. You can read about the Home & Community Care Transitions skilled nursing facility care prior approval process.