CommercialPrior AuthMedium impact
Prior Authorization Updates for Skilled Nursing Facilities
CareFirst BlueCross BlueShield·Family Medicine, Internal Medicine, Geriatrics·Prior Authorization
Effective date
Sep 11, 2023
We identified it
Jun 20, 2026
Summary
CareFirst BlueCross BlueShield has changed their skilled nursing facility prior authorization process. Instead of providing 14-day approvals after medical necessity review, they now auto-approve for 5 days, with utilization management reviewing medical necessity on day 6 for continued stays.
Action Required
Immediately: Update prior authorization workflows for CareFirst skilled nursing facility admissions. Billing team must adjust expectations for authorization timeframes - initial approvals are now 5 days instead of 14 days. Ensure providers are aware that continued stay reviews begin on day 6. Contact 1-866-PRE-AUTH (733-2884), option 1 for questions about specific cases.