Post-Acute Care Management for Medicare Advantage Members

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

Highmark has initiated a partnership with naviHealth effective August 1, 2014. naviHealth is a leader in post-acute care management and care transitions for health systems and health plans. This partnership is instrumental in bringing a personalized care transitions approach to support Highmark's Medicare Advantage members across Pennsylvania and West Virginia. naviHealth is guiding the way to better patient outcomes and generating cost savings through their clinical support services, proprietary technology, and advisory solutions. naviHealth offers a unique suite of care transition and decision support tools to predict patients' PAC needs and coordinate long term acute care, inpatient rehab, and skilled nursing utilization to ensure patients receive the most appropriate level of care for an optimal outcome. Through a highly collaborative process, this partnership enables us to improve member satisfaction, reduce readmission rates and improve patients’ functional recovery.

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 both acute and 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 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. 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 at-home or outpatient services.

Learn More About naviHealth and Post-Acute Care Services

Learn more about naviHealth by visiting their website.

Administrative Guide

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

 

Last updated on 11/14/2019

 

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