Before services are rendered, you may make certain updates to your notification/prior authorization request, depending on the status of the request and whether the service date has passed.
You may contact us at uhcprovider.com/paan, by phone at 1-877-842-3210, 1-888-478-4760 (Individual Exchanges) or the number provided on the member’s ID card, and we will let you know whether we updated your notification/prior authorization request.
If, during the service, you perform an additional or different procedure than what was originally approved, you are not required to modify the existing notification/prior authorization request, or request a new notification/prior authorization record for code combinations on the Prior Authorization Crosswalk table available at uhcprovider.com.
For code combinations not listed on the Prior Authorization Crosswalk table, you must contact us within 5 business days of rendering the service to advise of the changed or added procedure. If you do not contact us within 5 business days to advise of the changed or added procedure for code combinations not listed on the Prior Authorization Crosswalk table, and if the added or changed service is reduced or denied for lack of pre-service notification, you can request a clinical review by submitting records indicating why the original procedure code was changed or a new procedure code was added.
If we do not approve the notification/prior authorization request, you cannot make updates to it. You may submit an appeal by following the instructions listed in the adverse determination letter we send you.
This section applies to Commercial members only. It does not apply to notification/prior authorization requests for genetic and molecular testing, BRCA, oncology, radiology, cardiology and injectable medications.