Beginning June 7, UnitedHealthcare will require prior authorization for certain advanced outpatient imaging procedures for Medicare Advantage members whose claims are accessible online. As such, the insurer has developed tools that physicians can use to better understand this new requirement.
The Radiology Prior Authorization Program includes CT scans, MRIs, MRAs, PET scans, and nuclear medicine studies, including nuclear cardiology. To learn more about the program, go to UnitedHealthcareOnline.com > Clinical Resources > Radiology > Radiology Notification page and refer to the links under the Notification Resources: Reference Materials heading.
To understand these requirements further, physicians are encouraged to take advantage of the following new online tools:
An on-demand training course
A plan inclusion and exclusion grid
A quick reference guide
A 2010 CPT® code list
A 2010 CPT® code crosswalk table
Evidence-based clinical guidelines
To view the materials and take the on-demand training course, go to Clinician Resources > Radiology page on the UnitedHealthcareOnline website.
States with SecureHorizons and Evercare Medicare Advantage plans administered by UnitedHealthcare Online and subject to the UnitedHealthcare Provider Administrative Guide that are not participating in the program at this time are: Connecticut, Idaho, Nebraska, New Jersey Rhode Island, Oregon and Washington. All other sates are included in the June 7 effective date except Florida, which has an effective date of March 1, 2010.
This program does not apply to SecureHorizons and Evercare Medicare Advantage plans administered through PacifiCare or Oxford. Inpatient settings, observation units, emergency rooms and urgent care centers are also exempt from the notification requirement.