Prior Authorization and Site of Service Review Update

In the November and December issues of Network Bulletin, we communicated that the site of service utilization guidelines that apply to surgical and radiology procedures would be revised, effective Jan. 1, 2021, which would reflect the change below. Please disregard this previous notice.

For dates of service on and after Feb. 1, 2021, for UnitedHealthcare commercial benefit plans, including Oxford, Neighborhood Health Partnership and UnitedHealthcare of the River Valley, as well as Medicare Advantage, we are changing the age criteria in the utilization review guidelines from “less than 19 years of age” to “under 18 years of age.”

Updated utilization review guidelines that reflect the change above can be accessed from the UnitedHealthcare Commercial Medical Policy Update Bulletin: January 2021 and UnitedHealthcare Oxford Policy Update Bulletin: January 2021