Private insurer UnitedHealthcare (UHC) has announced plans to expand its site-of-service preauthorization guideline to most states on November 1, 2019.
As described in UHC’s September Provider Network Bulletin, the expansion will take effect on or after December 1, 2019, in California, Colorado, Connecticut, New Jersey and New York.
Alaska, Kentucky, Massachusetts, Maryland and Texas are excluded.
Preauthorization will apply to general surgery including 17 imaging- and MR-guided procedures, as well as urology, gastroenterology, gynecology and other medical specialties. Pediatric patients are excluded. The guideline only allows performance of these procedures in the hospital outpatient setting under limited circumstances.
UHC began site-of-service preauthorization for advanced diagnostic imaging services in early 2019.
In addition, the insurer announced new “enhanced functionality” for its online prior authorization and notification tool, which “may” improve authorization response times. An interactive guide to the changes can be examined on UHC’s website.
The new prior authorization system will be rolled out in stages, starting on October 1, with therapy services. More services will be gradually added through the early months of 2020. A specific date for medical imaging services has not yet been announced.