Texas Medicaid Updates Prior Authorization Process for Long-Term Skilled Nursing
According to UnitedHealthcare Community Plan of Texas, there is an announcement of a significant change to the previous process of prior authorization of the long-term skilled nursing services in Texas Medicaid.
It is effective immediately, so the providers should no longer place prior authorization requests directly with UnitedHealthcare on procedure codes S9123 and S9124. Rather, a provider has to call a service coordinator in order to seek an assessment in case a member needs long-term skilled nursing support.
In the new process, service coordinators will complete patient assessments and provide them to Texas Health and Human Services Commission (HHSC) to be evaluated as eligible under Home and Community-Based Services (HCBS) or Long-Term Services and Supports (LTSS). HHSC shall decide on the eligibility.
The UnitedHealthcare service coordinator can be contacted by calling 800-349-0550 by the providers who require assistance in the case of STAR+PLUS members.
The STAR+PLUS Medicaid program members who are subject to HCBS waivers might be eligible to receive long-term skilled nursing services that last six months or more, under the condition of medical need.
Long-Term Skilled Nursing Procedure Codes
- S9123: code used by a registered nurse for long-term home skilled nursing care.
- S9124: code used for home-based long-term skilled nursing care by a licensed vocational nurse.
In the case of acute skilled nursing, prior authorization is relevant to both procedure codes G0299 and G0300 regarding short-term care that is medically necessary in a home health or hospice facility by a registered or licensed practical nurse. Using One Healthcare ID, providers are able to send requests via the UnitedHealthcare Provider Portal.
If you believe our member, your patient, needs acute skilled nursing care, then:
- Using One Healthcare ID, providers are able to send requests via the UnitedHealthcare Provider Portal. If you don’t have a One Healthcare ID, register now
- From the left-hand tabs, select Prior Authorizations & Notifications
The UnitedHealthcare Provider Portal also offers 24/7 chat support to providers.
