New states in scope for naviHealth post-acute care

Beginning Aug. 1, 2021, naviHealth will start managing post-acute care for UnitedHealthcare® Medicare Advantage members in Alabama, Maine, Massachusetts, New Hampshire, Rhode Island, Tennessee and Vermont. This is in addition to the post-acute care management change that went into effect for certain states on April 1 and June 1, 2021.

This includes prior authorization, concurrent (continued stay) review and discharge planning for members transitioning to and receiving skilled care in:

  • Skilled nursing facilities (SNFs)
  • 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 the Tennessee Dual Complete One (FIDE) Plan   

Plans not included:

  • UnitedHealthcare Institutional Special Needs Plans (ISNP)
  • UnitedHealthcare Institutional-Equivalent Special Needs Plans (IE-SNP)
  • 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 the Tennessee Dual Complete One (FIDE) Plan
  • The Massachusetts Senior Care Options (MASCO) Plan

What happens next

You'll receive an email invitation to attend a provider education session. Attending the session will help ensure a smooth transition for you, your teams and our members.

Learn more about naviHealth and UnitedHealthcare at navihealth.com/united-provider-info. Please check back frequently for ongoing updates.

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