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:
Healthfirst removes some procedures off the prior auth list (2026)
For any DOS on Jan 1, 2026 and there after, Healthfirst will remove prior auth requirenment from the EviCore prior auth list. Please remember that member benefits (coverage vs non coverage) still applies. Find this type of information useful? Follow my blog for more!
Emblem Health to add more DME codes to prior auth list.
Are you a a DME provider or a physician that prescribes DME for Emblem Health members? Then this blog post is for you! Starting on for any DOS 13,2026 and thereafter the following DME codes will be added to the prior authorization list. If you find this type of content useful? Follow my blog for…
UHC to remove prior auth for some radiology and cardiology tests.
Starting Jan 1, 2026 certain nuclear imaging tests, OBGYN ultrasounds, and certain cardiology tests will no longer require a prior authorization for some of the following plan types: 1.UnitedHealthcare Insurance Company2.UnitedHealthcare Mid-Atlantic, inc. 3.UnitedHealthcare Plan of the River Valley, Inc. and 4.UnitedHealthcare Insurance Company of the River Valley5.Oxford Health Insurance, Inc.United Healthcare Level Funded (formerly All…
KR2 Medical Billing 