CommercialPrior AuthHigh impact
Prior Authorization Requirement for Transitions from Acute to Skilled Nursing Facilities Reinstated on Jan. 24, 2023
Medical Mutual of Ohio·Family Medicine, Internal Medicine, General Surgery +3 more·Prior Authorization
Effective date
Jan 24, 2023
We identified it
Jun 20, 2026
Summary
Medical Mutual is reinstating prior authorization requirements for patient transitions from acute care hospitals to skilled nursing facilities, effective January 24, 2023. The temporary waiver that allowed these transitions without prior auth has ended, and facilities must now obtain approval before transfers.
Action Required
Immediately: Case management and discharge planning teams must resume obtaining prior authorization from Medical Mutual before transferring patients from acute care to skilled nursing facilities. Update discharge workflows to include prior auth step. Contact Medical Mutual's prior authorization department before scheduling SNF transfers. Failure to obtain prior auth may result in claim denials or coverage issues.