Tag: Prior Authorization
UHC Prior Auth Going Paperless
UHC won’t be sending prior authorization and clinical decision letters by mail starting April 1.
This includes:
- Pre-service/prior authorization decision letters
- Inpatient review letters, including concurrent, retrospective, length of stay and level of care
- Extension for lack of clinical information letters
- Complex care management and OrthoNet letters available in Document Library
Instead, you can view them exclusively online 24/7 through either the UnitedHealthcare Provider Portal or an Application Programming Interface (API) system-to-system data feed.
Superior Prior Auth Requirements
Superior will be ending any active prior authorizations for Synagis® effective February 1, 2022 for all Superior Medicaid (STAR, STAR Health, STAR Kids, STAR+PLUS) and CHIP members to align with HHS guidance. As the season has ended, claims for Synagis® will no longer adjudicate pursuant to the end of the season per VDP guidance.
Superior HealthPlan will require prior authorization for CPT code 81519, Oncology Breast MRNA, for Medicaid, CHIP and Superior HealthPlan Medicare-Medicaid Plan (MMP) members. Superior HealthPlan will utilize Change Healthcare’s InterQual as the medical necessity review criteria. Effective on May 1, 2022
POET Is Seeing a Trend, UPDATE
On January 5th, Sir Seymore posted on Ink that POET is seeing a trend from Physician Offices that are trying to get a referral from Cigna MA.
Please scroll down to review that post for details.
POET received this information from Cigna MA: “Unfortunately, we’re experiencing a known enterprise-wide issue within the MHK/HSConnect platform that is affecting how many of our participating specialists are reflecting in the dropdown box or search box when attempting to generate a referral. The MHK/HSConnect team is working towards remediation but I have not yet heard when the expected date for completion might be.”
Just a reminder: SCPs do not need a referral due to the Public Health Emergency (PHE). The PHE has been extended until April 16, 2022.
PCPs and SCPs you are welcome to confirm participation with POET or Leslie.
Per Cigna MA, you should be able to manually enter the specialists’ (SCP) name/NPI for a referral.
United Healthcare Latest Updates
One Stop Shopping.
Click Below to get the latest updates on:
Policy and protocol
Reimbursement policy
Prior Authorization
And More
Two New Files Added
Reload document 
Open in new tab Texas Prepares to Inplement “GOLD CARD”
HAD YOUR FILL OF BURDENSOME PRIOR AUTHORIZATIONS?
For the Nitty Gritty of how House Bill 3459 is supposed to make your life easier follow this link to the TMA article by Joey Berlin.
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