Aetna
(This applies to ALL States)
Effective 12.14.2020 through Feb. 15, 2021 Aetna is temporarily making changes to the requirement for prior authorizations for post acute care facilities including SNF's. Initial pre-certification/prior authorization for admission to SNF is being waived for all Commercial and Medicare Advantage Plans. SNF's will be required to notify Aetna of the admission within 24 hours of admission either through Availity, or by calling Aetna directly. SNF's are also required to send medical records for concurrent review within three days of the initial admit. Medical records can be uploaded directly to Availity, or sent to Aetna by fax. Be sure to include patient name, and member ID on your fax cover sheet. Please note: there has been no clarification as to whether or not this applies to both in and out of network providers.
AvMed
(This applies to Florida ONLY)
No information regarding changes to prior authorization and SNF stays at this time. Auth is still required.
BayCare
(This applies to Florida ONLY)
BayCare Plus Medicare Advantage has temporarily waived the prior authorization requirement for admission to SNF, ARU, and LTACH levels of care. Baycare is requiring notification by the facility that the member is being admitted to and clinical documentation, supporting the reason for transfer. Baycare will follow normal concurrent review process and will continue to follow our members for discharge planning needs. Notification of admission can be submitted by phone or fax. Please note: this only applies to in-work providers, out of network providers should seek authorizations.
CarePlus
(This applies to Florida ONLY)
CarePlus states normal prior authorization requirements will resume August 16, 2020.
Cigna
Cigna will waive prior authorizations through March 31. 2021 for the transfer of its non-COVID-19 customers from acute inpatient hospitals to both in-network and out of network providers - LTACH's, SNF, and AR. In place of prior authorizations, Cigna will require notification from the post-acute care provider on the next business day following the transfer.
Florida Blue
(This applies to Florida ONLY)
Florida Blue Medicare, Commercial, and Affordable Care Act is waiving prior authorization requirements for patients being transferred from inpatient acute hospital settings to post-acute care facilities through Jan. 31, 2021 for both commercial and Medicare lines of business. Please see the attached for further details on notification to the plan.
Freedom Health & Optimum HealthCare
(This applies to Florida ONLY)
Freedom as of July 5, 2020 will begin to require authorization for SNF placement.
Humana
(state specific information below)
Humana is suspending authorization requirements for skilled nursing facilities (SNFs) and long-term acute care (LTAC) for Medicare Advantage and commercial members for the entire state of Indiana, South Carolina, and Texas through Jan. 31, 2021 for in-network providers.
Medica
Medica will suspend prior authorization for admission to a post-acute care setting through April 30, 2021.
