UnitedHealthcare Changes in Advance Notification and Prior Authorization Requirements

April 2019 ~

UnitedHealthcare (UHC) has posted a correction to authorization previously published code additions, as well as new codes requiring prior authorization.

These updates, published in the April 2019 Network Bulletin, can be seen below.

Correction to Code Additions to Prior Authorization published in January Network Bulletin

For dates of service on or after July 1, 2019, (changed from April 1, 2019) a new code will be added to prior authorization for the following plans: UnitedHealthcare Commercial Plans (UnitedHealthcare Mid-Atlantic Health Plan, Navigate, Neighborhood Health Partnership, UnitedHealthOne, UnitedHealthcare Commercial, UnitedHealthcare of the River Valley and UnitedHealthcare West).

Correction to Code Additions to Prior Authorization published in February Network Bulletin

The following codes will not require prior authorization for UnitedHealthcare Community Plans of Nebraska:

The following codes for UnitedHealthcare Community Plan of Pennsylvania, previously announced in the January and February Network Bulletins to be implemented for prior authorization, will be delayed from April 1, 2019 to May 1, 2019. For dates of service on or after May 1, 2019, the codes will require prior authorization:

Correction to Code Additions to Prior Authorization published in March Network Bulletin

Originally announced in the January Network Bulletin, for UnitedHealthcare Community Plan of California (Medi-Cal Plan), procedure codes for Cancer Supportive Care and Chemotherapy will require prior authorization starting April 1, 2019. In March, it was incorrectly communicated that this prior authorization requirement was due to a state mandate. Prior authorization for these codes is a plan requirement, not a state mandate:

Code Additions to Prior Authorization

Effective for dates of service on or after June 1, 2019, the following procedure codes will require prior authorization to be covered in an outpatient hospital setting for UnitedHealthcare Community Plan of New Jersey (Medicaid and LTC):

Source(s): UnitedHealthcare Network Bulletin April 2019;