Home health prior authorization review process no longer required

Change is part of nearly 10% reduction in prior authorization volume

Starting April 1, 2025, we’ll no longer require prior authorization or concurrent review processes for home health services managed by Home & Community (formerly naviHealth). These changes are part of ongoing efforts to reduce total UnitedHealthcare prior authorization volume. They represent the next step in our ongoing efforts to modernize the prior authorization process and simplify the health care experience for members and health care professionals.

Plans this applies to

This applies to UnitedHealthcare® Medicare Advantage plans and Dual Special Needs Plans (D-SNP) in the following states:

What you need to know

• Continue to request prior authorization and concurrent review for home health services for dates of service through March 31, 2025
• Although prior authorizations are no longer required for dates of service starting April 1, 2025, you are expected to provide home health services according to Centers for Medicare & Medicaid Services coverage guidelines
• Starting April 1, 2025, for states that require a Medicare denial to approve a Medicaid prior authorization, please submit your prior authorization requests using the UnitedHealthcare Provider Portal

Background

This year, UnitedHealthcare plans to remove prior authorization requirements representing nearly 10% of our total prior authorization volume. In 2023, we removed codes accounting for nearly 20% of our overall prior authorization volume, and last year we implemented a first-of-its-kind national Gold Card program for qualifying providers.

Questions?

If you have questions about delivering home health services, please contact your provider advocate or visit our Contact Us page.