Reminder: Home health care policy changed Jan. 1, 2019

The home health care policy has changed, and as of Jan. 1, 2019, all home health visits for Medicare and Medicaid members will require prior authorization before the first visit and will be subject to InterQual® criteria, Medicare guidelines, or the Medicaid provider manual. All commercial products will continue to be subject to InterQual® criteria for any prior authorization beyond 30 visits.

As of Jan. 1, 2019, faxed requests are only accepted for out of network providers, and all in network providers need to request prior authorization through the Clear Coverage tool.

View the policy here.

Training guides and more information on our prior authorization tool, Clear Coverage.

Additional information on this policy change.