From our partners at AETNA:
Hello Hospital Partner- an update that only applies for acute hospitals and SNFs
Attached noticed was supposed to go out to hospitals but in case you haven’t received or info didn’t make its way to you yet I wanted to make you aware that Aetna has liberalized Initial SNF Auths from Acute Care Hospitals since 11/22/21 and goes through 1/10/22. I attached a notice if need to share as has all the details. Please share as needed within your system.
**Note, is only for acute care hospital to SNFs, and they still need to notify (electronically preferred) within 48 hours and send medical records within 3 days of admission. I highlighted the main parts for you below from notice, but all details are there. Let me know if any questions!!!! Thanks for all you do! Stay Healthy and Happy Holiday Season!
Skilled Nursing Facility admissions from Acute Hospitals
• Initial Precertification/Prior Authorization for admission from acute care hospitals to Skilled Nursing Facilities (SNF) are waived for all Commercial and Medicare Advantage (MA) Part C plans.
• The SNFs will be required to notify Aetna of admissions within 48 hours. Providers may submit their request electronically though our provider portal on Availity or their preferred EDI vendor using the existing Precertification Request transaction. Providers can also submit their request by calling Aetna directly (refer to the back of the member’s ID cards for the correct telephone number).
• The Post-Acute care facility would also be required to send medical records for concurrent review within three days of the initial admission. Medical records can be uploaded directly through Aetna’s provider portal on Availity or sent to Aetna by fax to 1-833-596-0339. Please include the patient’s name and Member ID# on the cover sheet.
• Aetna requires:
o Hospital history and last two to three days of progress notes.
o Any information that demonstrates a need for Post-Acute care.
o Anticipated Discharge Plan with estimated length of stay.
• This change does not apply to transfer between facilities or level of care changes within a SNF.
• In addition, Aetna will continue to waive the three-day prior hospitalization requirements for skilled nursing facility stays, as part of our normal course of business.
• Our current policy for Home Health does not require precertification. Aetna plans to continue that process for contracted providers. Refer to Aetna DocFind for our contracted Home Agencies.
• Long-Term Care Hospital Admissions (LTACH) and Inpatient Acute Rehabilitation admissions still require a prior authorization for admission unless prohibited by state regulation. If a prior authorization is not completed, the admission will be reviewed retrospectively at claims submission.
• Temporary changes to reduce prior authorizations protocols for SNF admissions are effective through the above dates.