Medicaid: Prior Authorization changes effective through 02/28/2022

Date: 02/02/22

Heritage Health (Medicaid):

02/02/2022 Update: Prior authorization changes have now been extended for Medicaid through 02/28/2022.

 

To support the Nebraska Total Care membership and Nebraska Total Care Provider Network, the following changes will be effective through January 31, 2022:

Inpatient Admissions:  Nebraska Total Care will allow notification of admission up to 5 days post admission date and complete medical necessity reviews when notification is received.

Post-Acute Accommodations for rehab hospitals:

Nebraska Total Care will relax our requirements related to facility transfers including:

a. Nebraska Total Care will not require discharging acute care facilities to obtain prior authorization for patient transfers to participating post-acute facilities. 

b. Nebraska Total Care will not require sending facilities to provide notification of transfer to participating providers. 

c. However, Nebraska Total Care will require receiving facilities to notify the health plan of patient admission.  Nebraska Total Care will accept notification up to five days post-transfer.

d. Nebraska Total Care will continue to conduct medical necessity review

e. Because Nebraska Total Care will not have visibility prior to transfer, Nebraska Total Care request that hospitals utilize our in network post-acute facilities

Skilled Nursing Facilities: Nebraska Total Care will allow post admission notification and authorize up to a 7 day stay before medical necessity continued stay review.

If you have any questions, please contact Provider Relations at 1-844-385-2192 (TTY 711).