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Discharge Coordination Services for Medicare Advantage Members

November 05, 2012

We are introducing discharge coordination services for BlueCross BlueShield of South Carolina Medicare Advantage members. These services help ensure members receive appropriate care and follow up when hospitalized. This will lead to shorter inpatient stays, fewer inpatient re-admissions, fewer medical costs and better medication adherence.

A team of registered nurses will implement the discharge coordination services. This team will:  

  • Facilitate referrals to network providers, internal case managers and disease managers, as necessary.
  • Facilitate smooth transitions home. The team will work with hospital case managers and discharge planners to ensure a plan of care is in place.
  • Have an after-care conversation with members. The team will address any gaps in care as soon as possible.  

How Will It Work?

  1. Network hospitals will notify the inpatient discharge coordinator (IDC) within 24 hours or by the next business day after an admission.
  2. The IDC will enter the admission into a shared database. This database houses the Care Calls, case management, disease management and health management programs.
  3. The IDC will contact the hospital case manager or discharge planner to assess the plan of care and the discharge status/needs. These might include transfer to a lower level of care for continued treatment, discharge home with home health services support or another service. The IDC will guide hospital contacts to approved Medicare Advantage providers.
  4. Once the member is home, the IDC will place a follow-up “Care Call” to the member within 48 hours. The call finds and documents possible gaps in care so we can address interventions quickly. We can also identify any needs or referrals to internal case and disease management programs.

As a reminder, Medicare Advantage members are identified by the alpha prefix ZCT. Their ID cards will notify hospital staff to call our Inpatient Services department within 24 hours of admission. The phone number is 800-327-3183, ext. 25553. This program will begin January 1, 2013.

We appreciate your cooperation and compliance and look forward to working with you to enhance our members’ care. Please contact Provider.Education@bcbssc.com if you have questions or need additional information.

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