April 01, 2022

Colorado, Kentucky and Tennessee: New home health review process

Starting July 1, 2022, for UnitedHealthcare® Medicare Advantage and Dual Special Needs Plans (D-SNP), you’ll need to request prior authorization for all visits after the start of care (SOC) visit.

The visits included in the prior authorization will be:

  • 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 new process will apply to members enrolled in Medicare Advantage plans, including D-SNP members, who reside and receive services in Colorado, Kentucky and Tennessee. We’ll perform continuation of care reviews for Home Health Agencies (HHAs).

Plans out of scope for this new requirement include:

  • UnitedHealthcare commercial plan
  • United Healthcare Community Plan (Medicaid)
  • Any delegated provider medical groups
  • Institutional Special Needs Plans (I-SNP)
  • Long-Term Support Services Fully Integrated Dual Eligible Plans 

For states and UnitedHealthcare Medicare Advantage and D-SNP not mentioned, current existing requirements and processes remain unchanged. 

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 our 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-22-00894-M&R-News