This pharmacy bulletin outlines new or revised clinical programs and implementation dates. It’s available online for UnitedHealthcare commercial and UnitedHealthcare Oxford commercial plans.
Radiation therapy prior authorization update
Effective April 1, 2021, prior authorization for certain outpatient radiation therapies will be required for UnitedHealthcare commercial members. Effective April 1, 2021, prior authorization will be required for the following Radiation Therapy Services, in addition to Intensity Modulated Radiation Therapy and Proton Beam Therapy.
Electronic Payments and Statements (EPS) Kentucky | Massachusetts | Michigan | Missouri | Rhode Island | Washington | Wisconsin
Starting [date] we'll no longer be sending paper checks for provider payment in accordance with applicable laws.
Exchange plans: Prior authorization update Arizona | Maryland | North Carolina | Oklahoma | Tennessee | Virginia | Washington
Effective May 1, 2021, for Exchange plans prior authorization and notification requirements will be added for the following services: breast reconstruction, congenital heart disease, durable medical equipment, genetic and molecular testing including BRCA, gender dysphoria treatment w/diagnosis, orthotics and prosthetics, Rhinoplasty and other nasal surgeries and transportation services.
New Jersey: New timeframe for utilization reviews Effective June 1, 2021, for UnitedHealthcare commercial plans in New Jersey (including Oxford), the initial utilization review timeframe is changing to 72 hours for certain standard prior authorization requests, to meet state regulations (NJ HCAPP law).
New York: National Drug Code reporting Starting June 1, 2021, an accurate National Drug Code (NDC) must be reported for all physician-administered drugs billed on the Institutional Claim form