UnitedHealthcare to End Prior Authorization for Home Health Services in 2025
Beginning April 1, 2025, UnitedHealthcare will eliminate the need for prior authorization and concurrent review procedures for home health services managed by Home & Community, including naviHealth in their system. The insurer continues its organizational-wide strategy to lower prior authorization volume by 10% through this policy change while enhancing healthcare delivery for members and providers.
The updated policy from UnitedHealthcare will affect both Medicare Advantage and Dual Special Needs Plans (D-SNP) within the states as well as Washington, D.C. However, in Florida and Tennessee, existing requirements for D-SNP plans not managed by Home & Community will remain in effect.
- Alabama
- Alaska
- Arkansas
- California
- Colorado
- Connecticut
- Florida*
- Georgia
- Idaho
- Illinois
- Indiana
- Iowa
- Kansas
- Kentucky
- Louisiana
- Maine
- Maryland
- Massachusetts
- Nebraska
- Nevada
- New Mexico
- North Carolina
- North Dakota
- Ohio
- Oklahoma
- Oregon
- Pennsylvania
- Rhode Island
- South Carolina
- Tennessee*
- Texas
- Utah
- Virginia
- Washington
- Wisconsin
- Wyoming
- Washington, D.C.
Key Takeaways for Providers
- Healthcare providers must maintain their requests for prior authorization and concurrent review of home health services from March 31, 2025, to March 31, 2025.
- Starting April 1, 2025, home health services need to fulfill the requirements outlined by the Centers for Medicare & Medicaid Services (CMS) for coverage.
- Beginning with the UnitedHealthcare Provider Portal, service providers must submit all Medicare denial requests, which serve as approval for Medicaid prior authorization.
Background
The changes in regulation fit within UnitedHealthcare’s ongoing efforts to improve prior authorization methods. The insurer has eliminated prior authorization demands for procedures responsible for 20% of its total healthcare services during 2023. The Gold Card program from UnitedHealthcare originated in 2024 to offer qualifying providers automatic authorization exceptions for specific healthcare services at the national level.
Contact Information
For additional details about the policy, providers should contact their provider advocate or access information at the UnitedHealthcare Contact Us webpage.
