UnitedHealthcare is updating its prior authorization and concurrent review process for home health services that are delegated to Home & Community Care, the payer's home care division.
The changes take effect Jan. 1 and affect Medicare Advantage and Dual Special Needs plans, according to a Nov. 27 policy update from the payer.
Here are four things to know:
- Start of care visits still do not require prior authorization.
- Providers must notify Home & Community Care of the initiation of home care services. UnitedHealthcare encourages providing notice within five days after the start of a care visit to help avoid potential payment delays.
- Before the 30th day, providers must request prior authorization for days 30 to 60, by discipline, and provide documentation to Home & Community Care.
- For each subsequent 60-day period, providers must request prior authorization, by discipline, and provide documentation to Home & Community Care during the 56- to 60-day recertification window.