Last update: September 30, 2020, 9:00 p.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.
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 on Link.
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.
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.
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 firstname.lastname@example.org. 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:
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.
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.