| Plan type | Authorization guidelines |
|---|---|
| HMO/POS EPO, PPO (commercial plans) |
Authorization is not required for services from an in-network home health care provider.
If an HMO or EPO member is receiving care from an out-of-network provider, they will need an approved authorization for coverage because they do not have out-of-network benefits. |
| Medicare HMO Blue & Medicare PPO Blue | Authorization is not required. |
| Federal Employee Program | No precertification is required for Federal Employee program members. For FEP-specific benefit information, call 1-800-451-8124. |
Additional Information
Services should meet medical necessity criteria even though we are not authorizing them for coverage. For commercial, we continue to use InterQual® Home Care guidelines for post-service review.
For Medicare Advantage members, we continue to use CMS’ criteria for post-service review.
