Posted in #unitedhealthcare, Payer Updates, Training, Updates

UHC Community Health (Several States) anti-emetic prior authorization update

This policy is effective Aug. 1, 2021, and applies to the following states, UHC Community Health Plan:

Arizona, Kentucky and Tennessee that require prior authorization for outpatient injectable chemotherapy.

There are 8 anti-emetic codes (see below) that will be added to the prior authorization list, for patients that have cancer diagnosis. (Prior authorization requirements for outpatient injectable chemotherapy are not affected by this addition.)

Providers can choose from the preferred products (see below):

Preferred products are Emend®, Kytril® and Zofran®. For more information about preferred products, see the medical policy listed below.

How to submit prior authorization:

If the member received anti-emetic drugs in an outpatient setting for a cancer diagnosis from May 1, 2021, through July 31, 2021, you DO NOT need to submit a prior authorization request until a new anti-emetic drug will be administered.

UHC Community Health Plan will authorize the anti-emetic drug the member was receiving prior to Aug. 1, 2021, and the authorization will be effective until Jan. 31, 2022, unless a change in treatment is needed.

Please complete all notifications online. Sign into the UnitedHealthcare Provider PortalOpens in a new windowopen_in_new using your One Healthcare ID and select the Prior Authorization and Notification tool. Once you are in the tool, select Oncology, and when prompted, answer the questions about the service type, member type and state. You can submit authorizations for anti-emetics on July 1, 2021, in advance of the Aug. 1, 2021, requirement.

Coverage determination guidelines

On July 1, 2021, the Medical Benefit Drug Policy titled Anti-Emetics for Oncology will be available at:

Prior to July 1, 2021, the policy can be accessed from:

#UHC, #UHCommunityhealth, #KYmedicaid, #AZmedicaid, #TNmedicaid, #aprepitant, #rolapitant, #netupitant, #cancer, #oncology




My name is Kate Patskovska, CPB. I am an Independent Medical Biller CPB (AAPC) and an owner of KR2 Medical Billing. KR2 Medical Billing is a full service Consulting/Medical Billing Business that is dedicated to educating, consulting, and overall improving the "financial health" of your medical practice.

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