July 01, 2022

Connecticut, Florida, Indiana and Ohio: New home health prior authorization review process

Starting Oct. 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.

Impacted plans
This new process will apply to members enrolled in Medicare Advantage plans, including D-SNP members, who reside and receive services in Connecticut, Florida, Indiana and Ohio. We’ll perform continuation of care reviews for Home Health Agencies (HHAs).

Plans out of scope for this new requirement include:

  • UnitedHealthcare Commercial 
  • United Healthcare Community (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. 

Requesting 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.

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.

Note: Members with Delegated PCPs should follow the current process for authorizations. We are not making any changes to that process.

Questions?
If you have questions about the prior authorization submission process, email info@navihealth.com.

PCA-22-01827-M&RNews