Effective April 1, 2021, we instituted a 90-day continuity of care policy for our UnitedHealthcare Community Plan Hoosier Care Connect members coming from another Managed Care Entity (MCE) or Traditional Medicaid, or newly enrolled members.
The 90-day continuity of care period begins on the first day the member is effective with UnitedHealthcare Community Plan and ends on day 90.
Both in- and out-of-network providers are required to follow this policy. You must ensure member eligibility using Indiana’s Provider Healthcare Portal or the UnitedHealthcare Provider Portal to determine both:
The first date of eligibility
When the 90-day period expires
Prior authorization during 90-day period
We require all health care professionals who render services to our members to check if a service requires prior authorization and to obtain any required prior authorization. Please refer to this list of services requiring prior authorization.
If you have an existing prior authorization from another MCE or Traditional Medicaid, you can submit a copy of the approval to UnitedHealthcare. We’ll honor that prior authorization for the approved number of service units or 90 days from when the member joined UnitedHealthcare, whichever comes first.
During the new member’s 90-day continuity of care period only, if you fail to get a service authorized or don’t submit an approved letter from the member’s previous MCE or Traditional Medicaid, we'll still pay for the service as long as it’s a covered Medicaid service. Additionally, if the service did not require prior authorization by the member’s previous MCE or Traditional Medicaid, we'll still pay the claim.
After the new member’s 90-day continuity of care period ends, you’re required to obtain prior authorization to avoid a claim denial for failure to obtain a prior authorization.
To help facilitate the member’s transition to UnitedHealthcare, we have a full-time registered nurse coordinating member care between MCEs and Traditional Medicaid to and from UnitedHealthcare. Care transition questions can be sent to firstname.lastname@example.org.