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Updated prior authorization requirement for genetic and molecular codes

Updated prior authorization requirement for genetic and molecular codes

Newly issued AMA codes have been added to genetic and molecular prior authorization/advance notification program requirements

Effective Jan. 1 2024, we’ll require prior authorization or advance notification for newly issued genetic and molecular procedure codes. As new procedure codes are issued, it is standard practice for these codes to be added to existing prior authorization and advanced notification requirements.

Affected plans
This affects select UnitedHealthcare commercial plans and all UnitedHealthcare Individual Exchange plans, also referred to as UnitedHealthcare Individual & Family ACA Marketplace plans, as follows:

  • UnitedHealthcare of the Mid-Atlantic, Inc.
  • UnitedHealthcare Plan of the River Valley, Inc.
  • UnitedHealthcare Insurance Company of the River Valley
  • Oxford Health Insurance, Inc.
  • All Savers Insurance Company
  • All Savers Life Insurance Company of California
  • UnitedHealthcare Individual Exchange plans
  • Neighborhood Health Partnership, Inc.

What's Changing
In addition to the current in-scope procedure codes, we’re adding the following codes to the existing prior authorization/advance notification requirements:

  • 0403U
  • 0405U
  • 0409U
  • 0410U
  • 0411U
  • 0413U
  • 0417U
  • 0419U

How to submit a request
You can submit a prior authorization request through the UnitedHealthcare Provider Portal:

  • Go to UHCprovider.com and select Sign In at the top-right corner
  • Sign in to the portal using your One Healthcare ID and password
  • In the menu, select Prior Authorizations
  • In the Prior Authorization and Notification tool, scroll down to “Create a new notification or prior authorization request” and click Create New Submissions
  • Enter the required information and submit

You may continue to use the UnitedHealthcare Provider Portal to upload supporting documentation (solicited and unsolicited) for all claims. For more details, check out the Claims, Billing and Payments page.

For additional program information and live training, please visit our Genetic and Molecular Testing Prior Authorization/Advance Notification Program Website.

Chat with a live advocate 7 a.m.–7 p.m. CT from the UnitedHealthcare Provider Portal. You can also contact UnitedHealthcare Provider Services at 877-842-3210, TTY/RTT 711, 7 a.m.–5 p.m. CT, Monday–Friday.

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