FLASH: We’re Partnering with naviHealth

Effective May 1, 2013, we will partner with naviHealth (formerly SeniorMetrix) for post-acute care services for our Medicare Advantage ONLY. We’re excited at the new opportunities this partnership will bring to our members. naviHealth offers a comprehensive suite of functional assessment and clinical decision-support solutions to support evidence-based care.

naviHealth will act as an agent for us in care coordination for the post-acute space for our Medicare Advantage members. Your provider relation specialist and naviHealth will reach out to you directly to share more information about the partnership.

It is our shared goal that you experience minimal disruption. Under this new program, naviHealth care coordinators will collaborate with members, caregivers, and facility care managers to provide care transition planning and authorization of post-acute care.

The goal of this program is to arrange for the least restrictive, most appropriate site where a member can regain functional status most effectively. Though naviHealth will be responsible for the authorization for the Medicare Advantage post-acute care, your staff will continue to contact us to begin the preauthorization process.

In this program, preauthorization must be obtained from naviHealth for admissions and concurrent stays to a post-acute care setting. These settings include:

• Skilled Nursing Facility (SNF)
• Inpatient Rehabilitation Facility (IRF)
• Long Term Acute Care Facility (LTAC)
• Home Health services for therapy services

Note: We will retain responsibility to authorize Durable Medical Equipment (DME) and infusions in these settings.

The preauthorization program applies to our Medicare Advantage HMO and PPO members only.  Commercial, dual-eligibles, and Medicaid members are not included in this program, and existing authorization requirements remain unchanged as applicable through Health Alliance.

If you have any questions regarding this change, please do not hesitate to contact your provider relation specialist.

We appreciate your support and collaboration in assisting members experience better outcomes.