CommercialPrior AuthHigh impact
PAP708 - FEP Skilled Nursing Facility Requirements - updated FEP general admission and SNF rehabilitative care requirements
Blue Cross of Idaho·ID·Medical Policy
Effective date
Jan 1, 2021
We identified it
Jun 19, 2026
Summary
Blue Cross of Idaho updated FEP (Federal Employee Program) skilled nursing facility requirements, establishing new general admission criteria and SNF rehabilitative care standards effective January 1, 2021. Key changes include mandatory case management enrollment before admission, detailed precertification requirements with comprehensive assessments, and specific documentation standards for ongoing care.
Action Required
Immediately: Billing team must ensure all FEP members are enrolled in Transition of Care/Case Management before SNF admission and obtain signed consent. Update precertification workflows to include comprehensive assessments covering neurological, musculoskeletal, cardiopulmonary, integumentary, renal, mental health, and nutritional status. Establish regular reporting schedule (every 3-5 days minimum, every 7 days maximum) to provide progress updates including physician notes, medication reconciliation, and therapy logs. Verify SNF can provide all required services before issuing precertification. Claims will be denied without proper precertification and case management enrollment.