Medicare AdvantageDocumentationMedium impact
MA02.004a, Skilled Nursing Facility (SNF): Skilled and Subacute Levels of Care
Independence Blue Cross·Medical Policy
Effective date
Jan 6, 2025
We identified it
Jun 19, 2026
Summary
Medicare Advantage has updated the medical necessity criteria for Skilled Nursing Facility (SNF) services covering both skilled and subacute levels of care. This change affects how billing teams must document and justify SNF admissions and services for Medicare Advantage members.
Action Required
Effective January 6, 2025: Billing and clinical teams must review and update documentation procedures for all SNF admissions and services to ensure compliance with new medical necessity criteria. Verify that all Medicare Advantage SNF claims include appropriate justification for both skilled and subacute levels of care. Review the full policy at the provided URL to understand specific documentation requirements to prevent claim denials.