Commercial plan Prescription Drug List and Pharmacy Benefit Coverage Updates that will take effect May 1, 2021 are now available to view.

Beginning April 1, 2022, the entire claim will be denied if outpatient cardiovascular prior authorizations are not received or denied due to lack of medical necessity for Medicare Advantage plans.

UnitedHealthcare has created the Designated Diagnostic Provider Imaging – a tiered benefit design – to help members receive higher-quality, more affordable imaging services.

Our updated 2021 UnitedHealthcare Outpatient Procedure Grouper (OPG) Exhibit is available at UHCprovider.com/claims.

UnitedHealthcare Medicare Advantage requires providers in a Medicare jurisdiction that has implemented the MolDX program to submit the appropriate DEX Z-Code™ for molecular diagnostic test services.