Massachusetts: Prior authorization and site of service update

Update July 1, 2021: We previously announced a July 1, 2021 implementation date for prior authorization and site of service reviews for commercial plans in Massachusetts. Please note we’re delaying the implementation date to Jan. 1, 2022, as outlined below.

For dates of service on or after Jan. 1, 2022, for UnitedHealthcare commercial plans, we’re expanding our notification/prior authorization requirements to include certain surgical, screening colonoscopy, office and MR/CT imaging procedures in Massachusetts.

  • We’ll conduct site of service medical necessity reviews for surgical, screening colonoscopy and MR/CT imaging procedures if the procedure is requested to be performed in an outpatient hospital setting.
  • For office-based procedures, we’ll conduct site of service medical necessity reviews if the procedure is requested to be performed in an ambulatory surgical center.

We’ll use the following utilization review guidelines to facilitate these site of service medical necessity reviews:

More information is available in our Frequently Asked Questions:

Questions?

Please contact Provider Services at 800-666-1353.