FLASH: Skilled Nursing Facility Updated Checklist and Fast Pass for Authorization

Reminder: Health Alliance™, Health Alliance Northwest™ and Reid Health Alliance Medicare allow Fast Pass Skilled Nursing Facility (SNF) authorization for qualified members.

As the number of COVID-19 cases continues to be substantial, we’re committed to finding ways to ease your administrative burden and facilitate hospital throughput when possible. Last autumn, we created a Skilled Nursing Facility Checklist and Fast Pass Authorization to allow acute inpatient facilities to expedite their review of certain members to be admitted to a skilled nursing facility (SNF). This message today is to remind you that this initiative continues, and we encourage you to take advantage of it and use our helpful checklist when you do so. As a reminder, here’s what you need to know:

The SNF Fast Pass is specifically designed to be an option for the weekends (Friday, Saturday and Sunday), removing the need for the usual initial intervention from the health plan. Health Alliance, Health Alliance Northwest and Reid Health Alliance Medicare members who meet certain criteria can be issued a Fast Pass Authorization for SNF level of care. The authorization will include non-urgent ambulance transfer if required.

The goal of the Fast Pass Authorization is to facilitate inpatient hospital throughput of members who meet criteria for skilled nursing, by removing the need for the initial contact with the health plan. The member must qualify and meet criteria on the checklist in one of the following categories:

• Skilled therapy.
• Complex wound care.
• Intravenous therapy.
• High risk for readmission.

Members who do not meet criteria per the SNF checklist may still qualify for admission to skilled nursing. The hospital care team can request review by the health plan through the standard process of prior authorization request by phone or fax. Also remember, members who do not qualify for SNF placement are eligible for home healthcare services (which do not require prior authorization for the majority of our plans).

The Fast Pass approval will cover the first three SNF days. Approval of coverage beyond this initial three days is dependent on review of clinical information supplied to us by the skilled nursing facility.

An SNF Fast Pass approval does not guarantee payment. Providers should continue their normal processes of verifying member eligibility and network status of the referred-to facility. Payment of benefits are subject to all terms, conditions, limitations and exclusions of the member’s contract at the time of service.

Please visit Provider.HealthAlliance.org and click on “Prior Authorization and Referral Forms” to view the SNF Fast Pass clinical checklist, fillable letter template and FAQ documents.

As always, feel free to reach out to your provider relations specialist if you have any questions.