UHC Temporary Prior Auth Changes - Covid

December 21, 2020
 

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UnitedHealthcare Temporary Prior Authorization Program Changes – COVID-19

 

To decrease your administrative processes and help you dedicate more resources to patient care, UnitedHealthcare is temporarily suspending select prior authorization requirements for in-network hospitals and in-network Skilled Nursing Facilities (SNFs) nationwide due to an overwhelming increase in Emergency Department visits, admissions and transfers. The suspended requirements and dedicated support resources are being communicated directly to you as one of the impacted hospitals or facilities.

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. 8, 2021.

These temporary provisions include:

  • SNF prior authorization: We’re suspending prior authorization requirements for admission to in-network SNFs.
  • Transfer prior authorizations: We’re suspending prior authorization requirements when a member transfers from one facility to a new facility provider.
  • COVID-19-related oxygen requests: As a reminder, for orders involving COVID-19-related oxygen requests, oxygen can be delivered without prior authorization and does not need to meet current clinical criteria.
  • Discharge and post-care assistance: If your team needs assistance with discharge planning or finding post-acute care for patients with complex needs, please email COVID-19dischargeplanning@uhc.com.

Please note the following exceptions to the temporary provisions:

  • The provisions and effective dates noted here replace similar temporary prior authorization provisions for SNF admissions, facility transfers and COVID-19-related oxygen requests currently posted on UHCprovider.com/covid19 or communicated previously, unless the similar prior authorization provisions extended to higher levels of care or have expiration dates after Jan. 8, 2021.
  • State regulatory requirements, including end dates for specific state prior authorization relief requirements, still apply. Providers should check their state pages for more information.
  • For those areas where UnitedHealthcare will begin offering new Individual Exchange health plans beginning Jan. 1, 2021, the temporary provisions apply from Jan. 1, 2021 through Jan. 8, 2021.

 

After Jan. 8, 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 Link or an EDI 278N transmission that requires no intervention on the part of your staff.

For the most up-to-date information surrounding our other efforts related to COVID-19, please visit UHCprovider.com/covid19.

We will continue to monitor guidance issued by regulatory authorities and keep you posted as the COVID-19 crisis continues to evolve. As dedicated workers on the front lines of this pandemic, we deeply appreciate your efforts to fight this virus. Thank you again for all you’re doing.

Sincerely,

Signature

Signature

Ed Lagerstrom
President, UnitedHealthcare Networks

Anne Boland Docimo, M.D.
Chief Medical Officer, UnitedHealthcare

 

Insurance coverage provided by or through UnitedHealthcare Insurance Company or its affiliates. Health plan coverage provided by UnitedHealthcare of Arizona, Inc., UHC of California DBA UnitedHealthcare of California, UnitedHealthcare Benefits Plan of California, UnitedHealthcare of Colorado, Inc., UnitedHealthcare of the Mid-Atlantic, Inc., MAMSI Life and Health Insurance Company, UnitedHealthcare of New York, Inc., UnitedHealthcare Insurance Company of New York, UnitedHealthcare of Oklahoma, Inc., UnitedHealthcare of Oregon, Inc., UnitedHealthcare of Pennsylvania, Inc., UnitedHealthcare of Texas, Inc., UnitedHealthcare Benefits of Texas, Inc., UnitedHealthcare of Utah, Inc., UnitedHealthcare of Washington, Inc., Optimum Choice, Inc., Oxford Health Insurance, Inc., Oxford Health Plans (NJ), Inc., Oxford Health Plans (CT), Inc., All Savers Insurance Company, or other affiliates. Administrative services provided by OptumHealth Care Solutions, LLC, OptumRx, Oxford Health Plans LLC, United HealthCare Services, Inc., or other affiliates. Behavioral health products provided by U.S. Behavioral Health Plan, California (USBHPC), or its affiliates.

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