Last update: May 13, 2021, 10:38 a.m. CT
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 temporary suspension of prior authorization requirements for in-patient admissions to in-network skilled nursing facilities (SNFs) ends on Jan. 31, 2021, except for select markets which are being communicated to directly. The temporary prior authorization suspensions apply to UnitedHealthcare Medicare Advantage, Medicaid and Individual and Group Market health plan members nationwide, where UnitedHealthcare has health plans available. The suspensions are effective Dec. 18, 2020 through Jan. 31, 2021.
State variations and regulations may apply during this time. For Medicaid and other state-specific regulations, please refer to your state-specific website or your state’s UnitedHealthcare Community Plan website, if applicable.
Please note the following exceptions to the temporary provisions:
After Jan. 31, 2021, we may retrospectively review select services rendered during this time period. Admission notification is still required during this time, in alignment with the current protocol to support you in arranging post-admission care or other support services, if needed. In most cases, notification of inpatient admission is provided to UnitedHealthcare by the hospital or facility through the UnitedHealthcare Provider Portal or an EDI 278N transmission that requires no intervention on the part of your staff.
Beginning Oct. 1, 2020, for all commercial and UnitedHealthcare Community Plan plans included in the genetic and molecular testing program, we are suspending prior authorization and notification requirements for the following three genetic and molecular CPT codes performed in an outpatient setting:
These codes were part of the expansion of the online prior authorization and notification program for genetic and molecular testing that took effect on July 1, 2020. We’re suspending the codes indefinitely to ease the administrative burden for care providers during the COVID-19 national public health emergency. Please note that we will be reviewing claims for these codes to ensure they are being billed appropriately.
You can learn more about the genetic and molecular testing program online or in the Genetic and Molecular Lab Test tool.
The following prior authorization provisions apply to all Individual and Group Market health plans, and Medicaid and Medicare Advantage plans.
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.
Reimbursement – Recurring Supplies
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.
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.
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.