Important UnitedHealthcare Medicare Advantage post-acute care requirements
Last modified: May 12, 2023
Update: Added link to 2023 Care Provider Administrative Guide
Please be reminded that facilities contracted with UnitedHealthcare and providing post-acute inpatient services for UnitedHealthcare® Medicare Advantage members are required to obtain prior authorization before members can be admitted to a post-acute care facility.
These prior authorization requirements apply to UnitedHealthcare Medicare Advantage members receiving care in a Skilled Nursing Facility (SNF), Inpatient Rehabilitation Facility (IRF), or Long Term Acute Care Facility (LTAC).
Note: If you do not complete the prior authorization process before the member is admitted, we may deny the claims and the member cannot be billed for the service.
Our post-acute care requirements help ensure continuity of care for your patients, as well as contribute to improved health outcomes and lower cost for our members.
Members in scope
The prior authorization requirements will apply to members in the following benefit plans:
UnitedHealthcare Medicare Advantage (MA)
UnitedHealthcare Dual Special Needs Plan (DSNP)
Institutional Equivalent Special Needs Plans (IE-SNP) when transferring from a hospital setting
The prior authorization requirements will not apply to:
Members in Institutional Special Needs Plans (ISNP)
Members assigned to primary care physicians that are part of a delegated arrangement
Avoid denial of payment
To avoid denial of payment for a post-acute care admission:
Obtain an approved prior authorization before admission
Provide timely admission notification once member is admitted to facility