Reminder: Change in prior authorization administration for post-acute care services and home health, effective Jan. 1, 2026
Jan. 1, 2026
Effective Jan. 1, 2026, HealthSpring will manage prior authorizations for post-acute care services, including skilled nursing facility, inpatient rehabilitation, long-term acute care and home health.
For any dates of services before Dec. 29, refer to EviCore Healthcare. Authorizations approved by EviCore before Jan. 1, 2026, will remain effective with HealthSpring.
Starting Dec. 29. 2025, for dates of service beginning Jan. 1, 2026:
- Submit initial prior authorization requests to HealthSpring for dates of services beginning Jan. 1, 2026.
- Include the requesting and servicing facility name and National Provider Identifier in your requests to HealthSpring.
- Request prior authorization through our provider portal, Availity® Essentials. It’s the preferred and fastest method.
Key updates effective Jan. 1, 2026
- Providers will submit initial prior authorization requests to HealthSpring for inpatient PAC services.
- PAC facilities will submit concurrent review requests to HealthSpring at least two days prior to the current prior authorization end date.
- Home health agencies will submit initial prior authorization requests to HealthSpring for home health services.
- Home health agencies will submit requests for additional visits past Jan. 1 to HealthSpring.
- Requests must include the requesting and servicing facility name and NPI to align with Centers for Medicare & Medicaid Services guidelines.
- Requests for out-of-network facilities will be reviewed by a HealthSpring medical director.
- A list of procedural codes requiring prior authorization and our prior authorization forms are available on our provider website.
How to request prior authorization
Request prior authorization through our provider portal, Availity Essentials. It’s the preferred and fastest method. Refer to Availity for instructions on setting up an account and navigating the portal.
Additional information
Refer to this flyer for information on this change.