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:
Members excluded
The prior authorization requirements will not apply to:
Avoid denial of payment
To avoid denial of payment for a post-acute care admission:
Follow these guidelines to avoid liability for claims that are denied as a result of failure to follow protocols. Such claims are not billable to the member.
Questions?
If you have questions, refer to post-acute care contract requirements/protocols which can be found in the 2022 UnitedHealthcare Provider Administrative Guide.