Alabama and Georgia: Home health review process changes

Effective July 1, 2021, for UnitedHealthcare Medicare Advantage and Dual Special Needs Plans, we will require prior authorization for home health services.

  • This change is taking place for members enrolled in Medicare Advantage plans, including Dual Special Needs plan members, who reside and receive services in Alabama or Georgia 
  • Out-of-scope for this new requirement are all members in Medicare Advantage Institutional Special Needs Plans, UnitedHealthcare commercial plans and UnitedHealthcare Community Plans (Medicaid). For members in these plans, current existing requirements and processes remain unchanged. 

What you need to know

UnitedHealthcare will be delegating prior authorization for home health services to naviHealth for members who reside and receive services in Georgia and to myNEXUS for members who reside and receive services in Alabama. Both will utilize portal technology. To facilitate home health authorizations, the criteria in United’Healthcare's Medicare Advantage Prior Authorization Requirements will be used. 

How to request prior authorization and notification

To learn more about prior authorization processes in your state, please follow the links below:

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