Home health prior authorization review process changes, effective Jan. 1, 2024
Starting Jan. 1, 2024, we’re updating the prior authorization and concurrent review process for home health services that are delegated to Home & Community Care. This affects UnitedHealthcare® Medicare Advantage and Dual Special Needs Plans (D-SNP) in the states listed below.
Please note that start of care (SOC) visits still do not require prior authorization. Continue to request prior authorization for subsequent visits, as outlined below.
Affected states
This affects the following states:
- Alabama
- Alaska
- Arkansas
- California
- Colorado
- Connecticut
- Florida*
- Georgia
- Idaho
- Illinois
- Indiana
- Iowa
- Kansas
- Kentucky
- Louisiana
- Maine
- Maryland
- Massachusetts
- Nebraska
- Nevada
- New Mexico
- North Carolina
- North Dakota
- Ohio
- Oklahoma
- Oregon
- Pennsylvania
- Rhode Island
- South Carolina
- Tennessee*
- Texas
- Utah
- Virginia
- Washington
- Wisconsin
- Wyoming
- Washington, D.C.
*In Florida and Tennessee, Home & Community Care is only delegated for UnitedHealthcare Medicare Advantage members.
How the new process will work:
We will continue to delegate the authorization review processes for home health services to Home & Community Care. However, starting Jan 1, 2024, the following will apply:
- Start of care (SOC) visits still do not require prior authorization.
- You must notify Home & Community Care of the initiation of home care services. We encourage you to provide this notice within 5 days after the start of care visit to help avoid potential delays in payment.
- Home & Community Care will issue an auth ID number, followed by the Service Request Number (SRN) back to you. The SRN will apply to all home health services provided within the first 30 days, including the SOC visit
- Prior to day 30, you must request prior authorization for days 30-60, by discipline, and provide documentation to Home & Community Care
- Home & Community Care will review the documentation and issue a determination to you by discipline, per the plan of care
- For each subsequent 60-day period, you must request prior authorization, by discipline, and provide documentation to Home & Community Care during the 56-60-day recertification window
- Home & Community Care will review the documentation and issue a determination by discipline per the plan of care
Resources
- Review facilitation: We’ll use the criteria in our Medicare Advantage Prior Authorization Requirements to facilitate our home health authorizations and concurrent reviews.
- Training: Watch for an upcoming email from Home & Community Care regarding available training
Questions?
If you have questions about the prior authorization submission process, please email HHinfo@optum.com.
PCA-1-23-03953-POE-NN_11292023
