Tag: #naviHealth

Posted in #Medicareadvantage, MVP (NY/VT) Insurance Payer, Prior Authorization Insurance Carrier Updates, Updates

MVP to end its relationship with naviHealth, Inc

Posted on by KR2Medical Billing

Currently naviHealth, Inc handles Utilization and Case/Care Management for post-acute services—including Skilled Nursing Facility (SNF), Inpatient Rehabilitation Facility (IRF), and Home Health—for MVP Medicare Advantage, DualAccess, and DualAccess Complete Members.

However, MVP and naviHealth, Inc will end their contract as of Dec 31st 2025.

Starting on Jan 1,2025 MVP will process these requests in house.

More information to come in Nov 2025.

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Posted in #Medicareadvantage, #unitedhealthcare, Training, Updates

UHC Medicare Advantage: change in post-acute care management ,04/01/21

Posted on by KR2Medical Billing

UHC partnered up with naviHealth to manage certain post-acute care administrative processes for Medicare Advantage members in Arkansas, Kansas, Kentucky, Maryland, District of Columbia, Oklahoma, Oregon, South Carolina, Virginia, Washington and Wisconsin. This includes:

  • Prior authorization
  • Concurrent (continued stay) review and discharge planning for skilled nursing facilities (SNFs)
  • Acute inpatient rehab (AIR)
  • Long-term acute care (LTAC)

This change will take affect as of 04/01/21 and for all DOS thereafter.

The Plans that this change applies to are:

  • Medicare Advantage plans, previously managed by UnitedHealthcare
  • Dual Eligible Special Needs Plans (DSNP)
  • Chronic Special Needs Plans (CSNP)
  • The Medicare component of Fully Integrated Dual Eligible (FIDE) plan (as applicable to your state)   

Plans not included:

  • Any Medicare Advantage members included in a delegated risk agreement to provider medical groups (e.g., Optum Care Network)

Questions regarding UHC and naviHealth Partnership:

Please visit: UHC and naviHealth Partnership Launch – naviHealth

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

MVP NY – Home Health Approval Process-New 2021

Posted on by KR2Medical Billing

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.

Education:
• 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 mbean@navihealth.com with any questions.

Source: MVP fax Provider Communications.