New home health prior authorization review process

Starting Oct. 1, 2023, for UnitedHealthcare® Medicare Advantage and Dual Special Needs Plans 

(D-SNP) members in Alaska, Washington, D.C., Illinois, Maryland, North Dakota, Oregon and Virginia, you’ll need to request prior authorization for all visits after the start of care (SOC) visit through naviHealth. SOC visits do not require prior authorization.

Visits requiring prior authorization

• Continuation of care
• Resumption of care (ROC)
• Additional services
• Recertification

What you need to know

• We’ll delegate the initial authorization and concurrent review processes for home health services to naviHealth 
• We’ll use the criteria in our Medicare Advantage Prior Authorization Requirements to facilitate our home health authorizations and concurrent reviews
• You don’t need to request prior authorization for home health services furnished as part of a plan of care initiated prior to Oct. 1, including those still open on Oct. 1 
• All existing home health services as of Oct. 1 may continue and don’t require naviHealth’s review or prior authorization until you need a recertification or resumption of care 

Resources

• You can get more detailed information about this change, including how to submit a prior authorization through naviHealth, by reading our Medicare Advantage Prior authorization for home health services document
• If you have questions about the prior authorization submission process, email info@navihealth.com

PCA-1-23-01876-POE-NEWS_06072023