As part of the discharge plan the Utilization team can assist with the transfer of a member to a Skilled Nursing Facility (SNF)* or Long Term Care Facility (LCT), if the member’s contract provides benefits for such services. The following information will be required, as well as a physician order, if the patient has not been hospitalized prior to admittance:
- Member demographics, including the subscriber number
- Names of admitting and attending physicians
- Admitting diagnosis
- Clinical information supporting inpatient admission (i.e. InterQual Criteria)
- Route of admission
- Telephone number of the Facility Utilization Department where the member will be transferred
A 3-day hospital stay is not required, prior to utilizing SNF benefits.
The provider should notify HealthPlus 24 hours prior to the SNF admission by telephone or fax at:
Phone: (810) 230-2105
Fax: (810) 230-2002 or (989) 797-4022
In the event that the request for SNF or LTC services are not approved, the provider may appeal the decision.