Post-Acute Care Management for Medicare Advantage Members

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

Highmark West Virginia has initiated a partnership with naviHealth, a national acute care management company, to bring a personalized approach to support its Medicare Advantage members. 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 West Virginia for post-acute services. Where practical and appropriate, 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.

While naviHealth will manage those post-acute care services for Medicare Advantage members, Highmark West Virginia 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 Jan. 1, 2016 at no additional charge.

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 7/3/2019


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