Log In
Behavioral Health Medicare Advantage Concurrent Review
Effective May 1, 2025, requests for Medicare Advantage Behavioral Health concurrent review for additional inpatient days will be reviewed utilizing the Centers for Medicare & Medicaid Services (CMS) Medicare Coverage Database.
Moreover, an additional source that Behavioral Health Episodic Case Managers will use for medical necessity beginning May 1 is the Milliman Care Guidelines.
The determination for the additional inpatient days will be made based on the Medicare necessity criteria, which can be found on the CMS website.
For questions regarding this change, email BehavioralHealth@bcbsnc.com.
Blue Cross and Blue Shield of North Carolina does not discriminate on the basis of race, color, national origin, sex, age or disability in its health programs and activities. Learn more about our non-discrimination policy and no-cost services available to you.
Information in other languages: Español 中文 Tiếng Việt 한국어 Français العَرَبِيَّة Hmoob ру́сский Tagalog ગુજરાતી ភាសាខ្មែរ Deutsch हिन्दी ລາວ 日本語
© 2025 Blue Cross and Blue Shield of North Carolina. ®, SM Marks of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield plans. All other marks and names are property of their respective owners. Blue Cross and Blue Shield of North Carolina is an independent licensee of the Blue Cross and Blue Shield Association.