March 01, 2022

Home health review process changes

Arkansas Home Health Medicaid Medicare Pharmacy and Drugs Policy and Protocol Updates Prior Authorization South Carolina Texas

Starting June 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 visit (SOC).

The visits included in the prior authorization will be:

  • Continuation of care
  • Resumption of care (ROC)
  • Additional services
  • Recertification
  • SOC do not require prior authorization

This change will apply to members enrolled in Medicare Advantage plans, including D-SNP members, who reside and receive services in Arkansas, South Carolina and Texas. 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.

How to request prior authorization and notification

Additional information about the initial authorization and continued stay review processes in your state can be found at UHCprovider.com.

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