The change to the prior authorization process and concurrent review process will affect the Medicare Advantage and DualAccess (D-SNP) Members in New York and Vermont.

As of Jan 1 ,2024 the process for Home Health Services and Concurrent Review will be handled by naviHealth, Inc. d/b/a Optum Home and Community Care.

Important things to remember:

• Start of Care (SOC) visits will not require prior authorization
• Providers should submit the notice of initiation of start of care for home health services to Optum Home and Community Care within the 5 days after the Start of Care visit: the provider will receive an Authorization Id, AND MVP Authorization ID- for the FIRST 30 days of the services. The MVP Authorization ID will allow the member to receive services without the need for an authorization.
• Prior to day 30, Provider must request prior authorization for days 31-60, by discipline, and provide documentation to Optum Home and Community Care.
• For each subsequent 60-day period, Provider must request prior authorization, by discipline, and provide documentation to Optum Home & Community Care during the 56-60-day recertification window.

If you would like more information, please visit mvphealthcare.com/policies and select Provider Policies, Effective October 1, 2023 (PDF) and review the Utilization and Case Management section.

Do you find this type of information useful? Follow my blog for more updates. #medicalbilling #medicalcoding #reimbursement

Previous Blog Posts:

UHC commercial plans- new allergy testing policy-9/1/26

If you are an allergist that accepts UHC commercial plans in your office/facility? Then this blog post is for you! What is new? What will not be considered for reimbursement? The new reimbursement policy will go into the effect for any DOS on 9/1/26 and thereafter except the following states: AR, CO, KY, NC, NE,…

by KR2Medical Billing August 2, 2026

Aetna SGRT reimbursement update

If you are a provider that accepts Aetna members in your office? Then this blog post is for you! For any DOS 11/1/26 and there after Aetna will reimburse only quantity 1 for SGRT whole course of treatment – no matter how many treatment sessions were done. The affected plans: What does your office need…

by KR2Medical Billing July 31, 2026

Anthem BCBS telehealth claims update -9/1/26

If you are a NY provider that accepts Anthem BCBS members in your practice and performs telehealth services, then this blog post is for you! Starting on 9/1/26 and for any DOS thereafter the telehealth claims will be subject to Excludes 1 (in ICD-10-CM) notes. In order to avoid any issues with claim payment please…

by KR2Medical Billing July 30, 2026