Change in post-acute care (PAC) management

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.

This includes:

  • 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) 

Plans included: 

  • 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)

What’s next? 

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.

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