Prior authorization requirement for home health services (Medicare Advantage)
Governs prior authorization requirements for home health services for Anthem individual Medicare Advantage members in specified states and member ID prefixes; affects home health providers and impacted members/providers seeking authorization for services starting Sept 1, 2017.
No material clinical or coverage changes in this revision.
Prior Authorization and Applicability
Prior authorization criteria and applicability
Prior authorization is required for specified home health services for individual Medicare Advantage members whose Member ID card alpha prefixes match the listed values; the requirement applies to new requests for services with dates of service on or after Sept. 1, 2017.
ALL of the following
Member population
- Individual Medicare Advantage members in the following states: Colorado, Maine, New Hampshire, Wisconsin
States named in policy
Services requiring prior authorization
- Skilled Nursing
- Therapies: Physical Therapy, Occupational Therapy, Speech Therapy
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