April 01, 2022

Alabama: Home health review process changes

Starting July 1, 2022, for UnitedHealthcare® Medicare Advantage and Dual Special Needs Plans (D-SNP) in Alabama, there will be a change in the process for requesting prior authorization for all visits after the start of care visit (SOC). Beginning on July 1, you will no longer request prior authorizations from myNEXUS – instead prior authorization requests should be submitted through naviHealth.

The change applies to the following visit types:

  • Continuation of care
  • Resumption of care (ROC)
  • Additional services
  • Recertification

Note: SOC visits do not require prior authorization. 

You can request authorization using the naviHealth nH Access – naviHealth online portal, and you will receive an electronic notification of your request status via the portal. Portal requests are the preferred method for authorization requests, but if needed, naviHealth can accept requests by faxing the standardized cover sheet and documentation to 888-815-1808.

Impacted plans
This change will apply to members enrolled in Medicare Advantage plans, including D-SNP members, who reside and receive services in Alabama. We will perform continuation of care reviews for Home health agencies (HHAs).

What you need to know
UnitedHealthcare will delegate the initial authorization and concurrent review processes for home health services to naviHealth. naviHealth will utilize portal technology and automated decision support tools to help manage the processes that your agency will use to submit authorization requests. We’ll use the criteria in our Medicare Advantage Prior Authorization Requirements to facilitate home health authorizations and concurrent reviews.

Questions?
Additional information about the initial authorization and continued stay review processes in your state can be found in this prior authorization for home health services document If you have questions about the submission process, email info@navihealth.com.

PCA-22-00886-M&R-News