Kentucky: Prior authorization and site of service update

Update Aug. 1, 2021: We previously announced an Aug. 1, 2021, implementation date for prior authorization and site of service reviews for commercial plans in Kentucky. Please note, we’re delaying the implementation date to Oct. 1, 2021, as outlined below.

For dates of service on or after Oct. 1, 2021, for UnitedHealthcare commercial plans, we’re expanding our prior authorization requirements to include certain surgical, screening colonoscopy, office and MRI/CT imaging procedures in Kentucky.

• We’ll conduct site of service medical necessity reviews for surgical, screening colonoscopy and MRI/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:

• Outpatient Surgical Procedures – Site of Service
• Screening Colonoscopy Procedures – Site of Service
• Magnetic Resonance Imaging (MRI) and Computed Tomography (CT) Scan – Site of Service
• Office-Based Procedures – Site of Service

More information is available in our frequently asked questions:

• Site of Service MRI/CT Commercial FAQ

Questions?

Call Provider Services at 800-666-1353.

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