Effective April 1, 2021, you’ll be required to submit a prior authorization if you plan to bill for Synagis and Xolair on the medical benefit for a UnitedHealthcare Community Plan member in California or New York. These requirements will apply whether members are new to therapy or have already been receiving these medications.
We’ll honor existing authorizations for Xolair until the end date on the authorization or the date the member’s eligibility changes. You don’t need to submit a new prior authorization request for members who already have an authorization for Xolair on April 1, 2021.
You can submit prior authorization requests in the following ways:
If you administer these medications without first completing the prior authorization process, we may deny the claim and you won’t be able to balance bill members.