Last update: April 3, 2020, 8:00 p.m. CDT
UnitedHealthcare is working to help people access health care to the fullest extent possible as we come together to address this national emergency. We’re adopting measures that will reduce administrative burden for physicians and facilities, helping members more easily access the care they need under their benefit plan, and adjusting programs and services, as needed, to protect members and help limit the spread of the COVID-19 virus in communities.
The following prior authorization provisions apply to all Medicare Advantage, Medicaid and Individual and Group Market health plans and are effective March 24, 2020:
- Suspension of prior authorization requirements to a post-acute care setting through May 31, 2020. Details:
- Waiving prior authorization for admissions to long-term acute care facilities (LTAC), acute inpatient rehabilitation (AIR), and skilled nursing facilities (SNF).
- Consistent with existing policy, the admitting facility must notify us within 24 hours for weekday admissions or by 5 p.m. local time on the next business day for weekend and holiday admissions.
- Length of stay reviews still apply, including denials for days that exceed approved length.
- Discharges to home health will not require prior authorization.
- UnitedHealthcare is able to help providers with patient discharge planning to lower levels of care settings. Please email COVIDfirstname.lastname@example.org for assistance.
- Suspension of prior authorization requirements when a member transfers to a new provider through May 31, 2020. Details:
- Providers are not required to submit a new prior authorization when a member moves to a different yet similar site of care for the same service (e.g., hospital transfers or practice transfers).
- For inpatient and post-acute admissions, consistent with existing policy, the admitting facility must notify us within 24 hours for weekday admissions or by 5 p.m. local time on the next business day for weekend and holiday admissions.
- For other transfer circumstances, such as outpatient services, please contact us at the phone number on the back of the member’s ID card to transfer the existing authorization.
- Suspension of review for site of service until April 30, 2020 for the surgical codes listed here .
Additionally, prior authorization is not required for COVID-19 testing and COVID-19 testing-related visits during this emergency period.
We will not require prior authorizations for diagnostic radiology (diagnostic imaging) of the chest for COVID-19 patients during this national emergency. We urge providers to submit notification for CPT® codes 71250, 71260, 71270 for members with a COVID-19 diagnosis or suspected diagnosis, and who are enrolled in Medicaid and Individual and Group Market health plans. No notice is necessary for Medicare. Notification allows us to coordinate the care of our members who may have COVID-19 and better support them in their health care journey. For all other chest CTs, prior authorization continues to be required.
Out of an abundance of caution, we’re pausing all HouseCalls and Optum At Home in-person visits with our members until further notice, effective immediately (March 20, 2020). This does not apply to services provided somewhere other than in private homes, such as telephone services and treating patients in skilled nursing facilities.
Keeping our members, care providers and their families healthy and safe is our top priority during this challenging time. Please be assured that we’re working diligently to determine how we can safely resume HouseCalls and Optum At Home visits as quickly as possible. We’re continuously monitoring national and local updates from the Centers for Disease Control and Prevention (CDC), Centers for Medicare & Medicaid Services (CMS) and other outlets to adjust our policies as needed. We’ll provide an update as soon as we have more information.
UnitedHealthcare is closely monitoring the drug supply chain to determine if any coverage changes are necessary.
Early Prescription Refills
UnitedHealthcare members can fill existing prescriptions early (up to a 90-day refill) through direct pharmacy or mail order. To get an early refill, members can call the pharmacy number on their ID card or speak directly to a pharmacist.
We may also temporarily suspend or relax additional policies, as needed, in regions where inpatient capacity is most compromised and at risk.
Systems are being updated to reflect these changes. Please check back often for the latest information.
CPT® is a registered trademark of the American Medical Association.
We’re committed to keeping you up to date on COVID-19 – we’re monitoring your inquiries and working hard to answer your questions. Let us know how we’re doing.
We’ll be making daily updates to this site. Be sure to check back often for the latest information.
The benefits described on this website describe federal requirements and UnitedHealthcare national policy. Additional benefits may be available in some states and under some plans.