This information applies only to members with the coverage listed below in the HealthPlan Effective Dates section.
Prior authorization for radiation therapy services is required for members with the following coverage:
UnitedHealthcare Commercial Plans - Effective April 1, 2021
UnitedHealthcare Community Plans
UnitedHealthcare Commercial Plans - Effective November 7, 2021
UnitedHealthcare Commercial Plans - Effective April 1, 2022
UnitedHealthcare® Medicare Advantage, UnitedHealthcare West Medicare Advantage and UnitedHealthcare Community Plan (Dual Special Needs Plan) health plans effective June 7, 2022
Prior authorization requirements include the following radiation therapy modalities and services:
We're working with Optum, our affiliate, to support you in managing the prior authorization process. Optum offers solutions to help improve the care provider experience for transactions, such as submitting prior authorization requests. Here's how to submit your request:
Or call 888-397-8129 from 8 a.m. – 5 p.m. local time, Monday -Friday.
For medical policies and criteria, visit UHCprovider.com/policies
You can print radiation oncology clinical worksheets after signing into the UHCprovider.com/Prior Authorization and Notification tool.
Select “Radiology, Cardiology, Oncology and Radiation Oncology Transactions”
Select the service type of “Radiation Oncology” and any of the product types
You will then be redirected to the MBMNow website.
You can print radiation oncology clinical worksheets by navigating to the “Contact Us” tab from the MBMNow homepage.
Open the “User Guide” to view and access worksheets by primary diagnosis/cancer type
Select “Link to Worksheets”
The worksheets are sorted in alphabetical order by primary diagnosis/cancer type. Scroll to the desired section and print the appropriate page(s) as needed.