Posted in #unitedhealthcare, Training, Updates

UHC Providers: Genetic testing Penalty waiver has expired!

This blog post applies to genetic/molecular testing penalty waiver, that was available to providers/labs while UHC was transitioning to a new Prior Authorization and notification Platform, in 2021.


This process finished and as of Jan 1,2022 the waiver has expired!

In order to get paid for genetic/molecular testing, providers must request a prior authorization and/or an advanced notification, for any code that requires it.


Where to request prior auth/advanced notification?

Providers must go to  Prior Authorization and Notification platform or by call 877-303-7736.

Performing laboratories can submit advance notifications.

If a test requires prior authorization with clinical criteria, the request must be submitted by the ordering provider.


For the current list of genetic and molecular tests that require prior authorization/advance notification, please go to UHCprovider.com/paan > Advance Notification and Plan Requirement Resources.


Questions?
For more information about the genetic and molecular lab testing prior authorization/advance notification program, please visit the UnitedHealthcare genetic and molecular testing prior authorization/advance notification (PAAN) web page and review the genetic and molecular lab testing PAAN FAQs.


Prior authorization/advance notification training
UnitedHealthcare is offering live training sessions for the genetic and molecular testing prior authorization/advance notification (PAAN) program. To register for training, please visit the UnitedHealthcare genetic and molecular testing prior authorization/advance notification (PAAN) web page.


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Posted in #unitedhealthcare, Prior Authorization Insurance Carrier Updates, Training, Updates

UHC Commercial Plans: some radiotherapies do not require prior auth

This policy change applies to UHC Commercial Plans:

  • UnitedHealthcare Plan of the River Valley, Inc.
  • UnitedHealthcare Insurance Company of the River Valley
  • UnitedHealthcare of the Mid-Atlantic, Inc.
  • MAHP Life and Health Insurance Company
  • Neighborhood Health Partners
  • UHOne
  • All Savers (fractionation prior authorization requirement for All Savers will be delayed)
  • Rhode Island and Oxford Health Plan members will be excluded

If you are a provider seeing any of the patients with the above mentioned plans and refer them for some outpatient radiotherapies, then this change applies to you.


There are 8 Radiotherapy codes, when performed in outpatient setting will no longer require a prior authorization.

These codes are:

  • 37243-Vascular embolization or occlusion, for tumors, organ ischemia, or infarction
  • 61796-Stereotactic radiosurgery (particle beam, gamma ray or linear accelerator); 1 simple cranial lesion
  • 61797-Stereotactic radiosurgery (particle beam, gamma ray or linear accelerator); 1 simple cranial lesion
  • 61798-Stereotactic radiosurgery (particle beam, gamma ray or linear accelerator); 1 complex cranial lesion
  • 61799-Stereotactic radiosurgery (particle beam, gamma ray or linear accelerator); each additional cranial lesion, complex
  • 61800-Application of stereotactic headframe for stereotactic radiosurgery (List separately in addition to code for primary procedure)
  • 63620-Stereotactic radiosurgery (particle beam, gamma ray, or linear accelerator); 1 spinal lesion
  • 63621-Stereotactic radiosurgery (particle beam, gamma ray, or linear accelerator); each additional spinal lesion (List separately in addition to code for primary procedure)

If you would like to read the full coverage of determination, please click here.


If you are a provider that is ordering other types of outpatient radiotherapy, please ubmit an online prior authorization request, sign in to Link to access the Prior Authorization and Notification tool. Select the “Radiology, Cardiology, Oncology and Radiation Therapy” box. After selecting “commercial” as the product type, you’ll be directed to another website to process the authorization requests.


Find this type of content useful? Follow my blog for more prior authorization updates, medical billing and coding guideline updates, and medical/reimbursement policy updates.


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Posted in #Medicareadvantage, #unitedhealthcare, Training, Updates

UHC Commercial and Exchange Plans: update to Radiology Prior Auth List

As of December 1,2021 the following codes will be added to the radiology prior authorization list. These codes will require an authorization for DOS 12/01/2021 and thereafter.

The prior authorization for these codes WILL NOT APPLY TO The following situations: if the advanced imaging is done in-

  • Emergency room
  • Urgent care center
  • Observation unit
  • Inpatient stay

In case you missed it:

In June 2021, UHC also added more Radiology and Cardiology codes on the Prior Authorization List. These codes apply to UnitedHealthCare Community Plan, Medicare Advantage, commercial and exchange Plans


For complete details on the radiology protocol, refer to the current UnitedHealthcare Administrative Guide


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