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UnitedHealthcare Publishes Advance Notice and Pre-Certification Lists for 2013

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04/12/2013

In the March 2013 Network Bulletin UnitedHealthcare published tables of services requiring advance notification, prior authorization or precertification by type of member plan and service. The articles below will give you the page number of these tables, which you may access by clicking on this Network Bulletin.

Advance Notifixation List Updates for UnitedHealthcare Commercial Plans

As promised in 2012, United Healthcare has adopted a standard list of services requiring advance notification for their Commercial plans.  The list of these services will be in effect for service dates on or after April 1, 2013.  The initiation and processing of advance notification or prior authorization requests are the same as that in 2012, regardless of the type of plan.

Providers planning to perform a service on the Advanced Notification list should notify UnitedHealthcare in advance and they will inform you if a clinical coverage review is required.    Coverage is consistent with the member’s benefit plan where deductibles, coinsurance, copayments or items not covered by the plan will be in effect.

Providers will receive coverage confirmation of any approved notification or prior authorization.  However, this confirmation does not guarantee or authorize payment.  Payment of covered services is subject to the terms and conditions of a provider’s contract with UnitedHealthcare and the member’s benefit plan including exclusions, limitations, conditions, patient eligibility and claim processing requirements.  Tables of services requiring and not requiring advance notifications and prior authorizations can be found in the March Network Bulletin, pgs. 5-7.

Prior Authorication Review for Selected Injectable Medications for UnitedHealthcare Community Plan Members

Effective April 1, 2013, physicians will be required to obtain prior authorization before administering certain drugs covered under the medical benefit for UnitedHealthcare Community Plan members, including those members currently on therapy.  Authorization need not take place for services performed in an emergency room, observation unit, urgent care facility, or during an inpatient stay.  A table of these services can be found on pg. 19,

Proton Beam Radiation Therapy

Effective April 1, 2013, UnitedHealthcare will require prior authorization for Proton Beam Therapy (PBT) services.  Requests for prior authorization will be reviewed based on the UnitedHealthcare medical policy on PBT.

Precertification for Echocardiography Codes for Neighborhood Health Plan (NHP)

Effective July 1, 2013, NHP Partnership will add echocardiograms to its Cardiac Precertification list.  Echocardiograms performed in an outpatient setting will require preauthorization for CPT codes, 93303, 93304, 93306, 93307 and 93308.  CareCore National will process preauthorization requests and make medical necessity determinations based on evidence-based clinical guidelines.

Related Searches: Advanced Imaging Services, Coding, Medical Billing, Prior Authorization