Blue Cross and Blue Shield of North Carolina (Blue Cross NC) is committed to ensuring that our members have access to providers and facilities that deliver high-quality, high-value care throughout their health care journey.
To support this commitment, we continuously evaluate the performance of Skilled Nursing Facilities (SNF) in our network. This evaluation includes key outcome metrics such as:
- Hospital readmission rates
- Emergency department utilization
- Efficiency and length-of-stay metrics
In alignment with Centers for Medicare & Medicaid Services (CMS) expectations and our quality goals, we are working toward a SNF network composed of facilities that consistently achieve and maintain a CMS Overall Star Rating of 3 STARS or higher. This approach supports our efforts to improve care coordination, reduce avoidable hospitalizations, and enhance member outcomes.
We encourage all SNF partners to regularly review their CMS Five-Star Quality Rating and take proactive steps to improve performance where needed. You can access your current rating and related data through the CMS Provider Data Catalog here: Provider Information | Provider Data Catalog.
Please note: Participation in our network is contingent upon meeting CMS compliance standards and quality benchmarks. Facilities that fall below these thresholds may be subject to additional review or changes in network status, in accordance with CMS network adequacy and quality oversight requirements.
We appreciate your continued partnership and dedication to delivering high-quality, affordable care to our members.
