The Centers for Medicare & Medicaid (CMS) requires all Medicare members, including Dual Eligible Special Needs Plan (D-SNP) members to know costs prior to receiving non-covered services. This applies to all Medicare Advantage plans including but not limited to plans in Arizona, California, District of Columbia, Delaware, Florida, Hawaii, Iowa, Kansas, Kentucky, Louisiana, Maryland, Michigan, Missouri, Mississippi, North Carolina, Nebraska, New Mexico, New Jersey, New York, Ohio, Oklahoma, Pennsylvania, Tennessee, Texas, Virginia, Washington and Wisconsin. You’ll need to request a prior authorization if you know or have reason to believe that a service or item for a Medicare Advantage member may not be covered.
How to request a prior authorization
Use our Provider Authorization and Notification (PAAN) tool in the UnitedHealthcare Provider Portal to submit a prior authorization request. The PAAN tool doesn’t issue denials. It tells you if a procedure code requires a review or not. For more information, go to uhcprovider.com/paan.