Reminder: PDN and HHC prior authorization requests

Prior authorization (PA) for private duty nursing (PDN) and home health care (HHC) requests can be submitted through our outpatient utilization management fax line at 877-643-0672 or through the Availity Essentials platform:

• No hard limit of 60 calendar days for PDN or HHC authorization periods will be applied.
• PDN services require a PA for medical necessity reviewed with:

• Milliman Care Guidelines (MCG) 28th edition private duty nursing-ORG: PDN-2001(HC).
• Ohio Administrative Code (OAC) Rule 5160-12-02.3 Private Duty Nursing: procedures for service authorization.
• OAC Rule 5160-12-01| Home Health Services: provision requirements, coverage and service specification, and a framework of case-by-case medical determination for all home health services.
• These guidelines are available upon request from the health plan.

• HHC requires a PA after 18 combined visits regardless of modality.

To determine if a service requires a PA, reference the Prior authorization requirements page on our website.