Effective May 1, 2023, we will require prior authorization for the following outpatient radiation therapies for UnitedHealthcare Community Plan members in Kentucky:
As part of the new prior authorization requirement, we are also changing the way we manage requests.
Starting May 1, 2023, Optum®, a UnitedHealthcare affiliate, will manage prior authorization requests for the above-noted outpatient radiation therapies and existing prior authorization requirement for PBT. This change should not impact your process for submitting prior authorization requests.
For PBT, if prior authorization for these services is already approved for administered treatment prior to May 1, 2023, you do not need to submit a new prior authorization request for that approved treatment plan.
For IMRT, standard radiation therapy 2D/3D, IGRT, special services, Y90/SIRT or SBRT, including SRS services started between March 1, 2023, and April 30, 2023, you do not need to submit a prior authorization request. We’ll authorize the radiation therapy service(s) the member was receiving prior to May 1, 2023, and the authorization will be effective for 90 days from the treatment start date. For any further radiation therapy services that extend after 90 days from the treatment start date, we’ll require prior authorization before the start of services.
Submit your prior authorization request by signing into the UnitedHealthcare Provider Portal using your One Healthcare ID and the Prior Authorization and Notification tool. Once you’re in the tool:
The online tool will open on April 25, 2023, for prior authorization requests with a start date of May 1, 2023.
On May 1, 2023, medical policies for all radiation therapy services will be available at UnitedHealthcare Community Plan Medical & Drug Policies and Coverage Determination Guidelines.
A Radiation Therapy Prior Authorization – Self Paced Provider Training resource is available to help your staff streamline the prior authorization request submissions process.
For answers to specific questions, email email@example.com.