UnitedHealthcare Reminds Providers of Prior Authorization Process for Home Health Services
UnitedHealthcare Community Plan of Ohio delivered the prior authorization process notification to the Ohio Department of Medicaid at their request to guide home health and private duty nursing services. All medical necessity evaluations happen individually for service requests, even if providers do or do not have network agreements.
Authorization Process and Guidelines
A request evaluation takes place based on Ohio Administrative Code (OAC) 5160-1-01 and Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) standards whenever they apply. The main objective of care delivery is to match medical services that suit the individual health requirements of members precisely. According to OAC Rule 5160-26-03.1, the matter of approval durations for these services is unrestricted. There exists no set period, like 60 days for authorization validation.
Submission Process
The UnitedHealthcare Provider Portal located at UHCprovider.com requires a One Healthcare ID for logging in to submit requests. UHCprovider.com/access provides new users with a platform to generate their One Healthcare ID. After logging into their account, providers must access the Prior Authorizations section and then choose “Create a new notification or prior authorization request” before entering the required information, which leads to submission.
Supporting Documentation Requirements
The process of successful authorization needs detailed documentation that remains current to function effectively. This includes:
- Dated plan of care (POC)
- Current nursing hours schedule
- Two weeks of current nursing notes
- Current treatment and medication administration records
- Any other relevant documents
- Ongoing Care Adjustments
Ongoing Care Adjustments
Healthcare providers need to file new authorization requests that contain updated documentation whenever members experience clinical condition changes requiring care plan modifications. Yearly reassessments are also required.
