Audience: Hospitals and Skilled Nursing Facilities
Excellus BlueCross BlueShield (BCBS) has implemented the requirements included in the New York State Department of Financial Services’ (NYS DFS) Insurance Circular Letter No. 1 (2022) issued January 6, 2022, for its commercial and Safety Net lines of business. In addition, Excellus BCBS has voluntarily extended Circular Letter No. 1 requirements to its Medicare line of business.
The requirements of Circular Letter No. 1 are not extended to the Federal Employee Program (FEP). Some self-funded accounts may not wish to apply the terms of Circular Letter No. 1.
We’ve summarized the provisions of Circular Letter No. 1 below; please review the entire document for full details.
Beginning January 6, 2022 through February 5, 2022 (end date subject to extension), the following provisions are in place:
In-Network Hospital Transfers
Preauthorization requirements for in-network hospital transfers are suspended for thirty days beginning January 6, 2022.
- The hospital should use its best efforts to provide 48 hours’ notice to Excellus BCBS after the in-network transfer, including information necessary for Excellus BCBS to assist in care coordination and discharge planning.
In-Network Inpatient Rehabilitation Services Following an Inpatient Hospital Stay
Preauthorization requirements for in-network inpatient rehabilitation services following a hospital admission are suspended for thirty days beginning January 6, 2022.
- The hospital should use its best efforts to provide notice of the discharge to Excellus BCBS within 48 hours.
- Excellus BCBS may require the rehabilitation facility or skilled nursing facility to provide notification of the admission.
- Excellus BCBS may concurrently or retrospectively review inpatient rehabilitation services for medical necessity.
Please use the Find A Doctor tool for a list of in-network hospitals and skilled nursing facilities.
If you have any questions, please contact your Provider Relations representative
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