Post-Acute Care Management for Medicare Advantage Members

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The Post-Acute Care Management for Medicare Advantage Members is only applicable to Delaware, Pennsylvania, and West Virginia.

Highmark's partnership with Home & Community Care Transitions is only applicable in Pennsylvania and West Virginia.

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NOTE: This program is not applicable in Highmark's Southeastern PA (SEPA) market.

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

Highmark has a partnership with Home & Community Care Transitions to support its Medicare Advantage members across Pennsylvania and West Virginia with care transitions. Home & Community Care Transitions offers a unique suite of care transition and decision support tools to predict patients' Post-Acute Care (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.

Home & Community Care Transitions 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, Home & Community Care Transitions can have care coordinators on site to support your clinical team in the 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 Home & Community Care Transitions for admissions to and concurrent stays at skilled nursing facilities, long-term acute care hospitals, and inpatient rehabilitation facilities. While Home & Community Care Transitions 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 Home & Community Care Transitions and Post-Acute Care Services

• Program Administrative Guide
• Visit the Home & Community Care Website
  
• Contact Information
• FAQ for SNF Episodic Bundled Payment Program

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To request an authorization for post-acute care services in Delaware, you'll need to complete one of the following worksheet surveys:

• Skilled Nursing Facility Continued Stay Worksheet
• Skilled Nursing Facility Precertification (Initial) Worksheet
• Inpatient Rehabilitation (Initial or Continued Stay) Worksheet 
• Long Term Acute Care (Initial or Continued Stay) Worksheet

Highmark Delaware recommends submitting requests via the provider portal, however, providers may fax completed surveys to the following:

• Long Term Acute Care 833-581-1863 
• Inpatient Rehab Facility 800-416-9195 
• Skilled Nursing Facility 800-416-9195 

Note: Requests are not a guaranteed approval. Additional information may be requested from the Highmark Delaware Clinical Services Team. In addition, coverage for services may vary based on the terms of the benefit contract.