Medicare AdvantagePrior AuthHigh impact
Review Steps for Direct Admission to Postacute Settings
HealthSpring·General Practice, Internal Medicine, Family Medicine +9 more·Provider News
Effective date
Jul 30, 2026
We identified it
Aug 13, 2026
Summary
HealthSpring has issued updated guidance on prior authorization requirements for direct admissions to postacute settings (skilled nursing facilities, inpatient rehabilitation, long-term acute care, and home health). Billing teams must ensure three prerequisites are met before submitting prior authorization: medical necessity assessment, physician order and medical clearance, and bed availability confirmation. Requests should be submitted through the Availity® Essentials provider portal.
Action Required
Effective immediately (July 30, 2026): Billing and clinical teams must implement a three-step verification process before submitting any prior authorization requests to HealthSpring for direct admissions to postacute settings. (1) Clinical/utilization team must assess and document medical necessity for postacute care in the patient record. (2) Providers must obtain and attach physician order and medical clearance documentation. (3) Admissions/discharge planning staff must confirm bed availability at the accepting facility before submission. All prior authorization requests must be submitted through Availity® Essentials provider portal with required documentation attached. Update internal workflows, checklists, and EMR templates to include these three verification steps. Train all relevant staff (providers, billing, admissions, utilization review) on the new requirements. Failure to complete these steps before submission may result in prior authorization delays or denials, impacting admission timelines and patient care transitions.