For DOS 1/1/24 and thereafter UHC Medicare Advantage Plans that are part of Preferred Care Partners or Preferred Care Network (South Florida Region and are managed by UHC prior auth department) will require prior authorization for the following services:
- Intensity-modulated radiation therapy (IMRT)
- Proton beam therapy (PBT)
- Stereotactic body radiation therapy (SBRT), including stereotactic radiosurgery (SRS)
- Image-guided radiation therapy (IGRT)
- Special and associated services (e.g., dosimetry and special physics consults)
- Hypofractionation (fractionation) using IMRT, PBT and standard 2D/3D radiation therapy for prostate, breast, lung and bone metastasis cancers
- Selective internal radiation therapy (SIRT), Yttrium 90 (Y90) and implantable beta-emitting microspheres for treatment of malignant tumors
UHC Oncology Radiation Policy can be found here: https://www.uhcprovider.com/content/dam/provider/docs/public/policies/medadv-coverage-sum/radiation-oncologic-procedures.pdf
This prior authorization policy does not apply to the Medicare Advantage Plans as part of Preferred Care Partners or Preferred Care Network that are managed by Wellmed. For these members please refer to the WellMed website: https://eprg.wellmed.net/
Providers that perform any or all of these services should request an auth by following the below-listed steps:
- Go to UHCprovider.com and click Sign In at the top right corner
- Enter your One Healthcare ID and password
- If you don’t have a One Healthcare ID, visit UHCprovider.com/access to get started
- In the menu, select Prior Authorizations
- Scroll down to “Create a new notification or prior authorization request” and click Create New Submissions
- Select the following information:
- Service type: Radiation Oncology
- Product type: Medicare
- State: Florida
Providers can start prior authorization requests on the UHCProvider portal starting Dec 15,2023. Any authorization approved in December of 2023 will have a start date of 1/1/2024 or thereafter.
Providers that require assistance with prior authorization process can click hrere: https://chameleoncloud.io/review/4450-6060ba8182113/prod
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