UnitedHealthcare to allow update of approved prior authorizations

August 14, 2019
Area(s) of Interest: Payor Issues and Reimbursement 

UnitedHealthcare (UHC) announced in its June 2019 Network Bulletin that it will now allow physicians to update or modify an existing, approved prior authorization after the date of service. The change, effective immediately for its commercial lines of business, will address the situation where a physician determines at the time of service that a different or additional medically necessary procedure needed to be performed beyond that what was originally approved.

Physicians will now be able to make CPT code changes and modifications to an existing authorization by contacting UHC Provider Services at (877)842-3210 within five business days of the date of service and prior to submission of the claim. Physicians may be required to provide updated clinical information to UHC in order to modify the prior authorization.

The new prior authorization modification process will not, however, apply to the following services:

  • Genetic and molecular testing, including breast cancer gene codes
  • Injectable medications, including those for hemophilia
  • Oncology
  • Radiology
  • Cardiology

To further simplify post-service authorization changes, UHC has also instituted a Prior Authorization Crosswalk Table that identifies various approved prior authorization CPT code combinations that will not modification of a previous authorization prior to submission of the claim. 

The new policy represents a significant change in process for UnitedHealthcare, which previously only allowed post-service changes to prior authorized services for advanced outpatient imaging.

For additional information or questions regarding this change, contact UHC Provider Services at (877)842-3210.

Join CMA Today!

Explore why over 44,000 California physicians have joined CMA to advocate for patients, the medical profession and the future of health care.

Was this page helpful?