Post-Acute Care Management for Medicare Advantage Members

Skilled Nursing, Long-Term Acute Care and Inpatient Rehabilitation Facilities

Highmark has initiated a three-year partnership with naviHealth, a national post-acute care management company, to bring a personalized approach to support its Medicare Advantage members across Pennsylvania. According to patient needs, naviHealth will utilize decision-support technology and its post-acute analytics capabilities to coordinate long-term acute care, inpatient rehabilitation and skilled nursing facility utilization and will oversee proper care transitions to and from these facilities. Through a highly collaborative process, this partnership enables us to increase member satisfaction, lower readmission rates and improve clinical outcomes.

Through this effort, naviHealth care coordinators will work closely with Medicare Advantage members, caregivers and facility care managers to plan care transitions and provide authorizations on behalf of Highmark for post-acute care services. Where practical and appropriate, the naviHealth care coordinators can be on site to support your clinical team in the coordination, management and discharge of our members. The goal is to ensure members receive evidence- based care at the least restrictive, most appropriate site to enable them to regain functional status most effectively.

Prior authorization must be obtained from naviHealth for admissions to and concurrent stays at skilled nursing facilities, long-term acute care hospitals and inpatient rehabilitation facilities. Authorization requests should be submitted via NaviNet®. While naviHealth will manage those post-acute care services for Medicare Advantage members, Highmark will continue to directly manage authorizations for other post-acute services such as durable medical equipment, home health agency services and other products and services provided in the patient’s home.

This service will become part of our Medicare Advantage members' existing benefit plans beginning August 1, 2014 at no additional charge.

Learn More About naviHealth and Post-Acute Care Services Beginning August 1, 2014

Administrative Guide

  • Administrative Guide
    This reference document includes guidelines and requirements for the Post-Acute Care Management Program for Highmark's Medicare Advantage members.

Education

naviHealth will begin to authorize services for Pennsylvania Medicare Advantage members with a new admission to a facility for Post-Acute Care services on or after August 1, 2014. This general overview provides an introduction to naviHealth, and examples of how the authorization process works.

Audio is included; please ensure that your speakers and volume are adjusted accordingly.

Last updated on 7/3/2019

 

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