It is an algorithm (from naviHealth) that some UnitedHealthcare Medicare Advantage plans use to estimate how long a skilled nursing stay should last. A prediction is not a substitute for your doctor's and facility's assessment of your actual needs.

How fast do I have to appeal a skilled nursing cutoff?

Very fast. Follow the NOMNC and request an expedited QIO appeal by noon the day before your coverage is set to end. It costs nothing and pauses the clock.

Guides · UnitedHealthcare · appeals · Updated July 2026

How to appeal a UnitedHealthcare skilled nursing denial

UnitedHealthcare Medicare Advantage plans have faced lawsuits and a Senate investigation over using an algorithm (nH Predict, via naviHealth) to predict when to end skilled nursing coverage. Coverage must rest on your actual clinical need — not a prediction — which is the heart of the appeal.

Why UnitedHealthcare denies this

UnitedHealthcare Medicare Advantage plans often terminate skilled nursing or rehab coverage early, issuing a Notice of Medicare Non-Coverage based in part on an algorithmic length-of-stay prediction (nH Predict). Denials frequently claim you have "plateaued" even when skilled care is still medically necessary — including care to maintain function, not just improve it.

What wins the appeal

File the expedited appeal with the Quality Improvement Organization (QIO) by noon the day before coverage ends — the deadline on your NOMNC. Get the facility's therapy and nursing notes showing skilled care is still needed, and cite the Jimmo v. Sebelius settlement: Medicare covers skilled care to maintain or slow decline, not only to improve. Do not rely on the algorithm's prediction.

Your deadline

Depends on your plan type: 180 days for most employer and marketplace plans, 120 for Original Medicare, ~90 for Medicaid, and only 65 for Medicare Advantage. Set it before you do anything else.

Don't fight it alone — and don't miss the deadline

AppealClock translates your denial, drafts your appeal letter, and watches every deadline so you can't miss it. Free, no account, your medical details never leave your device.

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Common questions

What is nH Predict?: It is an algorithm (from naviHealth) that some UnitedHealthcare Medicare Advantage plans use to estimate how long a skilled nursing stay should last. A prediction is not a substitute for your doctor's and facility's assessment of your actual needs.
How fast do I have to appeal a skilled nursing cutoff?: Very fast. Follow the NOMNC and request an expedited QIO appeal by noon the day before your coverage is set to end. It costs nothing and pauses the clock.