Effective June 1, 2021, NaviHealth will start managing certain post-acute care medical management processes for Medicare Advantage members in Arizona, Colorado, Iowa, Michigan, Minnesota, Nebraska, New Mexico, North Dakota and South Dakota.
- Prior authorization for post-acute admissions
- Concurrent (continued stay) review and discharge planning for skilled nursing facilities (SNFs)
Level of care:
- Acute Inpatient Rehab (AIR)
- Long-Term Acute Care (LTAC)
- Medicare Advantage plans previously managed by UnitedHealthcare
- Dual Eligible Special Needs Plans (DSNP)
- Chronic Special Needs Plans (CSNP)
- The Medicare component of Fully Integrated Dual Eligible (FIDE) plans (as applicable to your state)
Plans not included:
- UnitedHealthcare Institutional Special Needs Plans (ISNP)
- UnitedHealthcare Institutional-Equivalent Special Needs Plans (IESNP)
- Any Medicare Advantage members included in a delegated risk agreement to provider medical groups (e.g., Optum Care Network)
- UnitedHealthcare commercial plans
- UnitedHealthcare Community Plans (Medicaid only plans)
- Long Term Support Services (LTSS)
- The Medicaid component of Fully Integrated Dual Eligible (FIDE)
In the upcoming months, you will receive an email invitation to attend a provider education session. Please be sure to attend a session so you and your team can learn more about the changing processes and be ready for the transition.
To learn more about naviHealth and the UnitedHealthcare partnership, visit navihealth.com/united-provider-info.