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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