QIO Immediate Review of SNF, CORF and HHA Discharges

Special expedited appeal rights for members being discharged from SNF, CORF or HHA services. 

Blue Cross and Blue Shield of Nebraska (BCSBNE) members receiving skilled nursing facility (SNF) care, home health agency (HHA) services or services at a comprehensive outpatient rehabilitation facility (CORF), have special appeal rights that allow an expedited review if they disagree with the decision to end covered services. 

The Medicare form Notice of Medicare Non-Coverage (NOMNC) is delivered to BCBSNE members by the providers of SNF, HHA or CORF services in one of the following situations: 

• When medical necessity criteria are no longer met and no additional days are authorized by BCBSNE or the facility/provider 
• At least two days prior to a scheduled discharge date 
• The NOMNC contains detailed instructions about how members may request an immediate appeal directly to the QIO if they disagree with the decision to end services