Last update: July 24, 2020, 9:45 a.m. CDT
To streamline operations for providers, we’re extending prior authorization timeframes for open and approved authorizations and we're suspending prior authorization requirements for many services. Review each of the sections below for effective dates and specific details. Please check back often for the latest information.
The following prior authorization provisions apply to all Individual and Group Market health plans, and Medicaid and Medicare Advantage plans.
- A 90-day extension, based on original authorization date, of open and approved prior authorizations with an end date or date of service between March 24, 2020 and May 31, 2020, for services at any care provider setting. For example, for a prior authorization with an original end date or date of service of April 30, 2020, the prior authorization would now extend through July 29, 2020.
- Applies to existing prior authorizations for medical, behavioral health and dental services. This includes existing prior authorizations for many provider-administered drugs.
- Authorizations issued on or after April 10, 2020 will not be subject to extension.
- Applies to in-network and out-of-network existing prior authorizations.
- Prior authorizations for inpatient procedures will extend 90 days from the expected admission date.
- Providers should re-confirm member eligibility before providing services, when authorized dates of service are extended, to help ensure that accurate coverage and benefits are applied.
- If a prior authorization approves the number of visits or services, then providers must obtain a new prior authorization for additional units, visits or services beyond what was approved in the original authorization.
- For example, if the original authorization approved 10 sessions of physical therapy, any sessions beyond 10 would require a new authorization.
- UnitedHealthcare will also follow related state mandates where applicable. However, when UnitedHealthcare provisions exceed those required by states, UnitedHealthcare provisions will apply.
- For example, if a state has mandated an extension of prior authorizations by 60 days and UnitedHealthcare has extended prior authorizations by 90 days, we will apply the 90-day time frame to the extension.
- Providers can check the status of authorizations by using either the Prior Authorization and Notification tool on Link or by visiting the website listed on the back of the member's ID card.
We will not require prior authorizations for diagnostic radiology for COVID-19 testing and testing-related services (diagnostic imaging) during the national public health emergency period. 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.
To help our members access the critical supplies they need and streamline operations for providers during the national public health emergency period, UnitedHealthcare is making changes to several durable medical equipment, prosthetics, orthotics and supplies (DMEPOS) processes and provisions. The following provisions for prior authorization, reimbursement of recurring supplies and proof of delivery are effective for Medicare Advantage, Medicaid and Individual and Group Market health plan members, with dates of delivery from March 31, 2020, until May 31, 2020. Coverage and payment is subject to member's benefit plan and the provider's contracts. Normal prior authorization requirements will resume June 1, 2020.
- For all COVID-19 discharges to home-based care requiring a respiratory assist device or a ventilator, the vendor can deliver on notification only to UnitedHealthcare for codes E0471, E0465, E0466 and E0467 for up to three months from time of delivery. Notification is requested and the claim must be submitted with the appropriate modifiers and diagnosis code (ICD-10). After the three-month period, a prior authorization will be required.
- For orders involving COVID-19-related oxygen requests, oxygen can be delivered without prior authorization and does not need to meet current clinical criteria.
- Where possible, we’re eliminating Face-To-Face evaluation requirements for the ordering provider for DMEPOS:
- For prior authorizations for services that were completed before Oct. 1, 2019, a new prior authorization is required. Provider may complete a Face-To-Face assessment via telehealth.
- For prior authorizations for services that were completed on Oct. 1, 2019, or later, UnitedHealthcare is extending prior authorizations through Sept. 30, 2020.
- For new DMEPOS prior authorizations, providers may complete a Face-To-Face assessment via telehealth.
- DMEPOS evaluation requirements remain in effect for complex rehab technology (CRT) and orthotics and prosthetics. However, vendors may use their own technology, if available, to minimize in-person contact.
- Prior authorization is not required for a DMEPOS repair when the claim uses the repair modifier.
- Consistent with existing policy, prior authorization is not required for breast pumps.
Reimbursement – Recurring Supplies
- The following changes to recurring supply processes will help maintain member supplies:
- For initial orders, we’ll reimburse beyond 30 days to cover a 30- to 45-day supply depending on packaging.
- For second orders, we’ll reimburse an additional 15-day supply to allow for overlap.
- For remaining orders, vendors may manage frequency and duration to help members maintain sufficient product on hand, but it is not to exceed 45 days on hand. Supply limits still apply.
Proof of Delivery
A physical signature from the patient is not required, but the vendor must note the time and date of delivery and relationship to member, in addition to maintaining required documentation for follow-up requests.
On May 11, 2020, the American Society for Reproductive Medicine issued guidance in support of the measured resumption of infertility treatments. Before resuming infertility treatments, providers should be flexible and prepared to recognize and address the status of their local COVID-19 transmission rate. Providers should review national, regional, state and municipal regulations that dictate what healthcare treatment is and is not permitted within their jurisdiction, based on their analysis of disease transmission and hospital capacity data.
Temporary Coverage Change for Embryo Cryopreservation
Previously, UnitedHealthcare announced a temporary policy change – effective for dates of service from March 17, 2020 through April 30, 2020 – to cover embryo cryopreservation in order to help members avoid mid-cycle disruption to infertility treatment accessed through their benefit plan. While this temporary coverage period has ended, here are the policy details to help ensure claims are submitted accurately and to help you understand the benefits payable from March 17, 2020 through April 30, 2020.
- The temporary change in coverage applied to infertility treatment care plans for members who started an in vitro fertilization (IVF) cycle and were ready for retrieval and embryo transfer, which was interrupted mid-cycle by the COVID-19 national emergency. It did not apply to previously scheduled cryopreservation services.
- UnitedHealthcare provided embryo cryopreservation coverage to fully insured members with infertility benefits, where plan benefits had not previously included embryo cryopreservation coverage.
- Members with fully insured coverage may, in some instances, already have benefit coverage for embryo cryopreservation when the issued policy includes a state-mandated requirement for this coverage. In that instance, the member will receive the higher level of coverage: either the temporary change in coverage or the state-mandated requirement for coverage.
- For members in self-funded benefit plans with infertility benefits who do not have coverage for embryo cryopreservation and storage, coverage was provided if their plan sponsor opted in to offer this temporary change in coverage.
- UnitedHealthcare adjudicates benefits according to plan terms, including member cost share. The plan benefit will define the member cost share.
If you receive a claim denial for embryo cryopreservation that meets the above criteria, you can submit a claim reconsideration using the reconsideration process outlined in the Provider Administrative Guide/Care Provider Manual, available at UHCprovider.com/guides.
Other infertility treatment care plan issues pertaining to adverse determinations affected by the COVID-19 pandemic may be addressed through a peer-to-peer review. To request a review, you can call us at 800-955-7615 or send a secure email to UHC_PeertoPeer_Scheduling@uhc.com.
Prior authorization requirements for admissions to a post-acute care setting are suspended from March 24, 2020 through May 31, 2020. This applies to all Medicare Advantage, Medicaid and Individual and Group Market health plans. Normal prior authorization requirements will resume June 1, 2020.
- Waiving prior authorization for admissions to long-term acute care facilities (LTAC), acute inpatient rehabilitation (AIR), and skilled nursing facilities (SNF).
- Length of stay reviews still apply, including denials for days that exceed approved length.
- Discharges to home health will not require prior authorization.
Reminder: Consistent with existing policy, the admitting facility must notify UnitedHealthcare within 24 hours for weekday admissions or by 5 p.m. local time on the next business day for weekend and holiday admissions.
Resources Available to Help With COVID-19 Discharge Planning
If you need assistance with COVID-19 discharge planning, please email UnitedHealthcare at email@example.com. Your questions will be handled by a special team focused on COVID-19 discharge matters. During this national emergency, we will generally respond to requests within two hours, from 8 a.m. to 8 p.m. Eastern Time. Team members are available to assist you seven days a week.
Things to keep in mind when you send your discharge planning questions
Please keep these tips in mind to help us coordinate our response to you and so we can respond to you efficiently and completely:
- Format your email subject line in the following way: [Facility/Institution Name; City, State]
- Include the following information in your email message:
- The name of your facility/institution
- The contact name of the person sending the email
- The contact information (phone and email) of the person sending the email
- The name, date of birth and insurance policy number of the member you are inquiring about
- A brief description of the assistance you need from us
- As with all communications involving sensitive member information, please be sure to send your message to us in a secure manner.
Please note that we can also assist with discharge planning for all patients during this time, even if unrelated to COVID-19. You can email us at the address above if you have discharge planning questions unrelated to COVID-19.
Site of service reviews for nearly 2,000 surgical codes have been suspended from March 24, 2020 until May 31, 2020 for all Medicaid and Individual and Group Market fully insured health plans. Normal prior authorization requirements will resume June 1, 2020.
Prior authorization requirements when a member transfers to a new provider are suspended from March 24, 2020 through May 31, 2020. This applies to all Medicare Advantage, Medicaid and Individual and Group Market health plans. Normal prior authorization requirements will resume June 1, 2020.
- 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 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.
Reminder: Consistent with existing policy for inpatient and post-acute admissions, the admitting facility must notify UnitedHealthcare within 24 hours for weekday admissions or by 5 p.m. local time on the next business day for weekend and holiday admissions.
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 and processes described on this website apply pursuant to federal requirements and UnitedHealthcare national policy during the national emergency. Additional benefits or limitations may apply in some states and under some plans during this time.
We will adjudicate benefits in accordance with the member’s health plan.
Medicaid Providers: UnitedHealthcare will reimburse out-of-network providers for COVID-19 testing-related visits and COVID-19 related treatment or services according to the rates outlined in the Medicaid Fee Schedule.