Pre-authorizations

To help support patient care:

  • Urgent and emergent transport does not require pre-authorization.
  • Any emergency room visit that results in an in-patient admission, directly related to COVID-19, does not require a pre-authorization.

Discharging members to post-acute settings
During this challenging time, we are committed to supporting our hospital partners in removing barriers to quickly discharge our members to alternate settings to accommodate care needs of critical patients related to the COVID-19 pandemic.

Effective immediately, if hospitals need to transfer a patient quickly due to the COVID-19 impact and do not have time to secure pre-authorization for post-acute care settings or home-based care (e.g., skilled nursing facilities, long-term acute care hospitals and inpatient rehabilitation), we will waive the pre-authorization requirements and instead require notification by both the discharging and receiving facility/provider within 24 hours for care coordination and concurrent review authorization. Patients may not be transferred to out-of-network facilities without approval.

We will continue to monitor the needs of our hospital partners and re-evaluate an extension beyond February 28, 2022, as needed.

Note: BCBS FEP is excluded from this pre-authorization waiver.

Quality and incentive programs

Medicare Quality Incentive Program
The hierarchical condition category (HCC) coding accepted by CMS will count toward gap closures in our Medicare Quality Incentive Program (QIP). See the telehealth visits section for more information.

HEDIS
Member reported blood pressure readings that meet the current blood pressure reporting criteria can be used for Healthcare Effectiveness Data and Information Set (HEDIS®) and closing member care gaps when captured via audio or video or electronically.

View all COVID-19 updates and resources.