Effective immediately, Medical Mutual is suspending its policy that requires home healthcare providers to obtain prior authorization for services. This means you are no longer required to obtain prior authorization for services delivered to Medicare Advantage members after 120 days. Additionally, no prior authorization is needed for commercial members requiring occupational therapy (OT), speech therapy (ST), home health aide (HHA), skilled nursing visit (SNV) and physical therapy (PT) visits beyond 120 days. Regardless of these changes, it is the home health provider’s responsibility to ensure that services provided to Medical Mutual members are medically necessary to be considered a covered service.
Throughout 2019, we will work to align our population health care model with a network of high-quality post-acute providers. The intent of this effort is to develop strong relationships that maximize the number of patients treated by this network and to advance care models that improve health outcomes and lower costs.
As a valued healthcare partner, we thank you for caring for our members. If you have questions, please contact your provider contracting representative.
Commercial Home Healthcare Request Form
Medicare Advantage Home Healthcare Request Form