Continued Stay Request Form for Inpatient Acute Rehabilitation and Skilled Nursing Facilities (SNF)

March 27, 2025

Effective May 1, 2025, providers will be required to complete a Concurrent Review Request Form when requesting a continued stay at an inpatient acute rehabilitation or SNF. The form contains all required information to complete a medical necessity review.

The form can be downloaded from our website at www.healthpartnersplans.com/forms. Once completed, you must fax it to our UM Department at 215-991-4125.

This change applies to all lines of business – Health Partners Plans Medicaid, Health Partners Plans CHIP, Jefferson Health Plans Medicare Advantage, and Jefferson Health Plans Individual and Family Plans.  


Thank you for being a valued provider for members in one or more of our health plans: Health Partners Plans Medicaid, Health Partners Plans CHIP, Jefferson Health Plans Medicare Advantage, and/or Jefferson Health Plans Individual and Family Plans.