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Skilled Nursing Facility Policies

Skilled Nursing claims for Blue Advantage members from Blue Advantage Participating providers should be filed to Blue Cross and Blue Shield of Alabama. Providers should utilize their NPI and file claims electronically with the members prefix and contract number as it appears on the identification card. Claims should be filed in the same manner that claims are filed to the Medicare Part A Intermediary. Non-participating Blue Advantage Skilled Nursing Facilities providers should file claims for Blue Advantage members in the same manner and format used when filing to traditional Medicare.

Blue Advantage participating Skilled Nursing Facility providers must pre-certify. Member discharged on a weekend or holiday must be pre-certified within 24 hours following the end of the weekend or holiday. Precertifications may be faxed to 1-888-243-0031. Care Coordinators may be reached at 1-888-341-5030.

Questions and Answers

1. If a patient has TWO admissions to a SNF during the same benefit period, will they owe copayments for each admission?

Depending on the Blue Advantage option the member has chosen, there is only one copayment for each benefit period regardless of the number of admissions. Refer to online benefits for copayment amounts and benefit period information.

For additional information contact your Network Services Representative.