Commercial authorization changes for the behavioral health concurrent review process

Blue Cross and Blue Shield of North Carolina (Blue Cross NC) recognizes the important role of addressing Behavioral Health concerns in a timely manner and ensuring that the appropriate care is received for the appropriate timeframes.

As a valued provider who is also committed to making sure our members receive quality behavioral health care, we ask for your partnership as we take a more proactive approach to ensuring that we meet this initiative.   

For Commercial Plans, Blue Cross NC will adjust our concurrent review length of stay guidelines beginning August 1, 2023. Our goal is to collaborate with providers to identify members in need of additional discharge planning support and to be ready to assist with transitioning the member to the next appropriate level of care as soon as medically appropriate. 

Upcoming Changes: 

Initial Review Approvals for Inpatient and Residential Treatment Centers will receive a 7-day length-of-stay.

Concurrent Review Approvals for Inpatient and Residential Treatment Centers will receive no more than 7-day length-of-stay.

This enhancement will help with: 

More effectively managing members' transition-of-care phases. 

Developing strategies to reduce members’ length-of-stay. 

Please refer to the MCG Guidelines for Behavioral Health Inpatient and Residential Treatment Center for medical necessity criteria for initial and continued care.