UnitedHealthcare corporate headquarters in Minnetonka, MN. Credit: Ken Wolter/Shutterstock
UnitedHealthcare has notified providers that it will eliminate prior authorizations for home health services managed by Optum Home & Community (formerly NaviHealth). The change, which applies to Medicare Advantage and dual special needs plans, will take effect on April 1 in more than 30 states.
“We’ll no longer require prior authorization or concurrent review processes for home health services managed by Home & Community,” the company said. “These changes are part of ongoing efforts to reduce total UnitedHealthcare prior authorization volume. They represent the next step in our ongoing efforts to modernize the prior authorization process and simplify the health care experience for members and health care professionals.”
Recommended For You
The families of two deceased UnitedHealthcare Medicare Advantage members sued Optum Home & Community in 2023, alleging that the NaviHealth algorithm it used wrongfully denied post-acute care. The company told Becker’s Payer Issues at the time that the tool was not used to make coverage decisions.
"The tool is used as a guide to help us inform providers, families and other caregivers about what sort of assistance and care the patient may need, both in the facility and after returning home," the spokesperson said. "Coverage decisions are based on CMS coverage criteria and the terms of the member's plan."
Last month, a federal judge allowed some of the plaintiffs' claims made in the lawsuit to move forward. In January 2024, the company rebranded NaviHealth as Optum Home & Community Care, which is part of Optum Health.
The announcement is the latest in a series of moves by UnitedHealthcare to revise its prior authorization policies.
“This year, UnitedHealthcare plans to remove prior authorization requirements representing nearly 10% of our total prior authorization volume,” the company announced. “In 2023, we removed codes accounting for nearly 20% of our overall prior authorization volume, and last year we implemented a first-of-its-kind gold card program for qualifying providers.”
The gold card program recognizes qualified practices that consistently have demonstrated adherence to evidence-based guidelines. Qualified practices submit an advance notification that eliminates the need for clinical documentation review for specific services.
© 2025 ALM Global, LLC, All Rights Reserved. Request academic re-use from www.copyright.com. All other uses, submit a request to [email protected]. For more information visit Asset & Logo Licensing.
Alan Goforth
Alan Goforth is a freelance writer in suburban Kansas City. In addition to freelancing for several publications, he has written a dozen books about sports and other topics.
