Posted in MVP (NY/VT) Insurance Payer, NY Providers, Training, Updates

MVP NY – Home Health Approval Process-New 2021

This new process is an auto-approval, that would streamline the first time initial HH request.

This policy change applies to all MVP Medicare Advantage Members requiring HH admissions.

Provider will have to send in their request through naviHealth.

The providers will receive 10 pre-approved visits, which would include the Start of Care (SOC) visit.

Starting 01/01/2021- naviHealth will utilize Change Healthcare’s InterQual home health criteria for continued stay requests, additional services, and recertification’s.

• naviHealth will provide educational webinars (Details to come)
What will the webinars include?
• An overview of the new HH auto-approval process
• A detailed look at the revised naviHealth HH authorization request form
– There will be an opportunity for questions & answers
Who should attend?
• HH agency billing/Insurance areas
• HH agency intake department manager

Please contact the naviHealth Senior Clinical Manager, Monica Bean at with any questions.

Source: MVP fax Provider Communications.

Posted in Updates

Billing for Multiple Home Health Visits -UHC update, September 2020

According to UHC, in order to prevent payment issues for multiple skilled nursing visits on the same day, providers need to bill in the following manner:

a. Bill each visit on its own line

b. Bill each visit with its RVU and  HCPCS/CPT codes

c. The subsequent visits should be billed with a qualifying modifier (ex. XE)

Adding the appropriate modifier will ensure that the additional visit will be identified and processed for payment correctly, at expected rate.

For more information, please click here, for UHC Medicare Advantage Guidelines/Definitions. .