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Changes impact how skilled nursing facilities (SNFs) manage authorizations, verify resident coverage and receive reimbursement.
Medicare Advantage changes taking effect January 1, 2027, could significantly impact how skilled nursing facilities (SNFs) manage authorizations, verify resident coverage and receive reimbursement.
Two developments require immediate attention: Humana's transition to OneHome for skilled nursing utilization management and reductions in Medicare Advantage plan offerings across certain markets.
With Medicare's Annual Enrollment Period ending December 7, 2026, SNF operators should begin preparing now to minimize authorization delays, claim denials and disruptions to cash flow.
What Is Changing for Medicare Advantage in 2027?
1. Humana Is Transitioning SNF Utilization Management to OneHome
Effective January 1, 2027, OneHome will replace Home & Community Care Transitions (formerly naviHealth) as the utilization management provider for Humana's Medicare Advantage HMO and PPO networks.
The resident's admission date determines authorization routing:
- Before January 1, 2027: Continue submitting through Home & Community Care Transitions.
- On or after January 1, 2027: Submit through OneHome, preferably using Availity. Fax submissions will also be accepted.
The transition also requires EHR integration with Post Acute Analytics' Anna™ platform to exchange admission, discharge and transfer (ADT) data and clinical documentation. According to Humana's guidance, this integration is provided at no cost.
SNFs should coordinate with their EHR vendors and complete integration testing before January 1.
2. Medicare Advantage Plan Reductions May Affect Resident Coverage
Several insurers are reducing Medicare Advantage offerings or exiting select markets in 2027, potentially requiring residents to select new coverage.
For skilled nursing facilities, these changes can introduce financial and operational risks, including:
- Incorrect payer information and eligibility discrepancies
- Missed or delayed prior authorizations
- Changes to reimbursement rates and payer requirements
- Increased claim denials and aging accounts receivable
Facilities should identify affected residents before the December 7 enrollment deadline and verify updated coverage information before January claims are submitted.
How Should Skilled Nursing Facilities Prepare for 2027 Medicare Advantage Changes?
Proactive coordination between admissions, clinical teams and business office staff is essential. Polaris Group recommends seven steps to help SNFs prepare.
1. Review resident coverage. Identify residents enrolled in Medicare Advantage plans, flag terminating or changing plans and separately track Humana MA HMO/PPO residents.
2. Communicate with residents and families. Notify residents of potential coverage changes and request updated insurance information. Facilities can explain billing implications but should not recommend specific plans.
3. Verify eligibility and payer requirements. Confirm plan details, member IDs, effective dates and authorization requirements. Recheck eligibility in January.
4. Update authorization workflows. Document submission channels, continued-stay review requirements and escalation contacts. Ensure staff understand Humana's admission-date routing rules.
5. Complete EHR integration and staff training. Coordinate Anna™ integration, test workflows and train admissions and billing teams before January 1.
6. Strengthen clinical documentation. Ensure nursing and therapy notes consistently support skilled need, treatment goals and discharge planning to reduce authorization and medical necessity challenges.
7. Monitor claims and accounts receivable. Track transition-related denials, authorization delays and unpaid claims. Conduct weekly claims reviews throughout Q1 2027 to identify reimbursement issues early.
Key Medicare Advantage Deadlines for SNFs
December 7, 2026
Medicare Annual Enrollment Period ends
December 2026
Finalize authorization workflows, EHR integration and staff training
January 1, 2027
Humana OneHome transition and 2027 plan changes take effect
Q1 2027
Monitor claims, denials and accounts receivable
Frequently Asked Questions About 2027 Medicare Advantage Changes
Who will manage Humana SNF authorizations in 2027?
Beginning January 1, 2027, OneHome will manage skilled nursing utilization management for Humana Medicare Advantage HMO and PPO admissions occurring on or after that date.
Will skilled nursing facilities need new technology for Humana authorizations?
Yes. Humana's transition guidance requires integration with Post Acute Analytics' Anna™ platform for ADT data and clinical documentation. The integration is provided at no cost.
How could Medicare Advantage plan reductions affect SNF reimbursement?
Plan changes may result in new authorization requirements, payer discrepancies, reimbursement differences and claim denials. Early eligibility verification and ongoing claims monitoring can help reduce these risks.
Prepare Your SNF for 2027 With Polaris Group
Medicare Advantage changes introduce additional complexity for skilled nursing facilities already navigating evolving reimbursement requirements, staffing demands and administrative pressures.
Polaris Group helps skilled nursing facilities strengthen clinical operations, improve revenue cycle performance and navigate reimbursement challenges. Our clinical and financial consulting expertise can help facilities prepare for payer transitions while protecting revenue and maintaining operational efficiency.
Contact Polaris Group to learn how our team can support your facility through the 2027 Medicare Advantage transition.
