What to Ask About Prior Authorization Before a Skilled Nursing Admission
A skilled nursing facility can accept a patient clinically while the Medicare Advantage plan is still deciding whether it will authorize coverage.
Track the authorization as its own workflow. Do not assume “the bed is accepted” means “the plan approved the stay.”
Identify who submits the request
Ask:
- hospital utilization/case-management team?
- SNF admissions?
- treating clinician?
- another organization?
Write down the responsible person.
Record the request details
Requested service: skilled nursing facility care
Facility: ____________________
Requested start date: ____________________
Request submitted: ____________________
Plan received: ____________________
Standard or expedited: ____________________
Reference number: ____________________
Ask what documentation is pending
Plans may need clinical notes, therapy evaluations, functional status, diagnoses, or other information.
Ask:
“Is the request complete, or is the plan waiting for additional information?”
If more is needed, identify who owns the response.
Know the current federal decision timeframes
Beginning in 2026, CMS requires impacted payers including Medicare Advantage organizations to issue prior-authorization decisions for medical items/services as expeditiously as the patient’s condition requires and, subject to that condition, no later than:
- 72 hours for expedited requests; and
- 7 calendar days for standard requests.
Those are authorization-decision deadlines—not guarantees that a facility bed will remain available or that transfer will occur by that time.
Ask for the actual decision
Status labels should be precise:
- not submitted;
- submitted;
- incomplete;
- under review;
- approved;
- partially approved;
- denied;
- canceled/withdrawn.
Ask for the authorization number and approved dates/services.
Check conditions
An approval may be limited by:
- start/end dates;
- facility;
- number of days before review;
- network status;
- service level; or
- continued-stay review.
Ask the plan/facility what the authorization actually covers.
Prior-authorization card
Plan: ____________________
Facility: ____________________
Submitted by: ____________________
Submitted date/time: ____________________
Standard/expedited: ____________________
Missing information: ____________________
Reference number: ____________________
Decision: ____________________
Approved service dates: ____________________
Conditions/next review: ____________________
Frequently asked questions
Does authorization guarantee Medicare Advantage will pay every day?
No. Coverage still depends on the terms of the authorization, eligibility, continued-care criteria, and plan rules.
Can the family ask for expedited review?
Ask the treating team and plan whether the clinical circumstances meet expedited-review criteria.
What if the decision is late?
Contact the plan, document the request/receipt time, and ask about escalation/appeal/grievance options.
The practical goal
A prior authorization should be traceable from submission → receipt → complete file → decision → approved dates/conditions.
If one link is missing, the admission is not financially settled.
Related NHP guides
- Hospital Transfer Delayed by Insurance Authorization: How to Plan the Gap
- Medicare Advantage Denied Rehab: What Can Families Do Next?
Primary sources checked
- CMS — Improving Prior Authorization Processes
- Medicare — Compare Medicare Advantage Plan Types
- CMS — Prior Authorization Final Rule
*Editorial/source review: October 15, 2026. General education only. Notice rights, network status, prior authorization, billing liability, and appeal deadlines must be confirmed from the beneficiary’s actual plan and documents.*
