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Utilization Review for Inpatient Rehabilitation Services Effective January 1

Audience: Hospitals, skilled nursing facilities

Excellus BlueCross BlueShield would like you to be aware of an upcoming reduction in the allowed time frame health plans will have to make preauthorization determinations and provide written and verbal notice for inpatient rehabilitation services provided by a skilled nursing facility or hospital when the admission follows an inpatient stay. This change is to comply with NYS Public Health Law [Section 4903(2)(a)] and NYS Insurance Law Section 4903(b)(1).

Effective January 1, 2021, health plans must complete the review and determination process within one business day of receipt of all pertinent information. This change applies to all lines of business except Medicare Advantage and self-funded groups. 
Please note: This change applies only to inpatient rehabilitation services. The time frame for other preauthorization requests will remain three business days of receipt of all pertinent information.

Additionally, effective January 1, 2021, utilization review appeals must be determined within 30 days, rather than 60 days.

Thank you for the care that you provide to our valued members. If you have questions, please contact your Provider Relations representative.

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