New home health prior authorization review process
Effective May 1, 2023, 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 through naviHealth.
The visits included in the prior authorization will be:
This new process will apply to members enrolled in Medicare Advantage plans, including D-SNP members, who receive services in Idaho, Louisiana, Nevada, New Mexico, North Carolina and Washington. We’ll perform continuation of care reviews for Home Health Agencies (HHAs). For states and UnitedHealthcare Medicare Advantage and D-SNP not mentioned, current existing requirements and processes remain unchanged
Plans not affected by this new requirement include:
UnitedHealthcare commercial plan
UnitedHealthcare Community Plan
Institutional Special Needs Plans (I-SNP), Institutional Equivalent Special Needs Plans (I-ESNPs)
Long-Term Support Services Fully Integrated Dual Eligible Plans (i.e., FIDE and MMP)
Any delegated provider medical groups
What you need to know
We will delegate the initial authorization and concurrent review processes for home health services to naviHealth. We’ll use the criteria in our Advance Notification and Plan Requirement Resources to facilitate our home health authorizations and concurrent reviews. You can request authorization using the naviHealth online portal. You will receive an electronic notification of your request status through the portal.
If you have questions about the prior authorization submission process, email firstname.lastname@example.org.