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December 12, 2023

We’re committed to improving health outcomes and helping Medicare Advantage (MA) members receive the appropriate level of high-quality care while ensuring providers follow the standard of care for medical procedures. To that end, we’re implementing two important updates to our post-acute care and home health authorization processes.

Effective Jan. 1, 2024, Carelon Medical Benefits Management will administer all authorizations for services delivered to MA members through home health agencies. Providers have been advised to send pre-authorization and reauthorization (concurrent review) requests for home health services to Carelon.

Effective Feb. 1, 2024, Carelon will administer all authorizations for services delivered to MA members at post-acute care facilities. Providers have been advised to send pre-authorization and reauthorization requests for the following types of post-acute care to Carelon:

• Skilled nursing facilities (SNFs)
• Long-term acute care (LTAC)
• Inpatient rehabilitation (IPR), also known as inpatient rehabilitation facilities (IPFR)

Because these services are provided over a period of time and members’ needs change (e.g., differing levels and lengths of care), these updates will help ensure our members continue to receive the most appropriate services according to their medical need at time of service. We've updated our MA pre-authorization list on our provider website.

Questions? Please contact your Medicare sales representative.