June 09, 2021

United Healthcare Responds to ACR and Stakeholders on Prior Authorization Tool Changes

United Healthcare (UHC) updated its radiation therapy prior authorization tool based on recommendations from the American College of Radiology® (ACR®), the American Society for Radiation Oncology and the Association of Community Cancer Centers to improve the tool for radiation oncology practices and patients. The UHC tool launched on April 1.

Based on the associations’ initial feedback, UHC removed techniques that were not relevant for specific tumor types and clinical scenarios to decrease confusion and burden for practice staff who are entering the required information. In addition, they will continue to make changes to the platform to meet the needs of radiation oncology practices and their members.

UHC advises practice staff preparing the electronic prior authorization request to have the following information readily available including: tumor stage, treatment site, radiation dose prescribed and the number of fractions. This information will be used to support the determination of medical necessity, to increase processing time and reduce the need for additional information from the treating provider through a peer-to-peer conversation.

UHC has created a user guide, FAQ document and a self-paced video demonstration of the Radiation Therapy Prior Authorization tool on the UHC provider website. They ensure their team's telephonic response time has averaged 15 seconds since the launch of the tool.

UHC continues to develop ways to allow the selection of multiple delivery CPT codes simultaneously as a standard process in the prior authorization tool, where appropriate. The ACR applauds UHC for its openness to work with the provider community and looks forward to continued dialogue to refine the prior authorization tool.

If you have questions or concerns with the prior authorization tool or process, contact Alicia Blakey, ACR Sr. Economic Policy Analyst.