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Precertification Changes Due to COVID-19

Updated 05/15/2020 - After evaluating our current state status on COVID-19, BCBSKS will continue to waive the inpatient pre-certification and continued stay review requirement for COVID-19 admissions until June 30,2020.

So that hospitals can focus on the medical and clinical needs of their patients, effective Monday, April 13, 2020 through May 31, 2020, BCBSKS will waive the inpatient pre-certification and continued stay review requirement for COVID-19 admissions.  When a COVID-19 patient is admitted, we ask that hospitals notify our medical review staff via telephone, fax or the online system to provide the admission and discharge dates.  However, no clinical information or medical records will be requested.

We ask that hospitals continue to submit pre-certifications for non-COVID-19 admissions using the online portal, but BCBSKS will extend the number of approved days for each admission which will reduce the number of continued stay reviews required.

To improve access to medical care, BCBSKS is temporarily expanding the situations in which the use of telehealth technology is acceptable to use. This expansion will include doctors and other health care providers for the diagnosis and treatment of COVID-19, as well as other conditions that are medically reasonable to be treated in this manner. We are also expanding access to virtual hospice services, partial hospitalization and hospital-based physical, speech and occupational therapy services.

We recognize that it may become necessary for our acute hospitals to transfer non-COVID-19 patients to alternative care settings.  Upon notification of the transfer, BCBSKS will approve admissions to long term acute care (LTAC) and inpatient rehab settings without requesting medical records.

We have published COVID-19 related billing, coding and coverage information on the BCBSKS website and we are conducting a series of webinars for the hospitals this week. If you have questions, please contact your BCBSKS Institutional provider consultant.