Provider administered drugs prior authorization updates

Effective for dates of service starting Feb. 1, 2023, we will require prior authorization for the following medications and CPT® codes:

Determination and review timeline

We will complete prior authorization reviews according to state-defined requirements. Notifications of the case determination, including appeal rights when applicable, will be provided within the required time frame.

We’ll issue a denial decision if we don’t receive sufficient clinical information to complete the review. To prevent denials due to a lack of information, include all required clinical information when you submit the prior authorization request.

Please submit prior authorization requests according to the plan protocols.

How to submit prior authorization

• Sign in to the UnitedHealthcare Provider Portal using your One Healthcare ID
• Click on the Prior Authorization and Notification tool
• Select Create a new notification or prior authorization request
• Enter the required information on the submission site

Questions?

For questions related to these prior authorization requirements, call the Provider Services number on the member’s health care ID card.

CPT® is a registered trademark of the American Medical Association.

PCA-1-22-04295-C&S-News_12122022