Ask the expert: Am I required to respond to medical record requests for commercial risk adjustment?

March 17, 2023

UnitedHealthcare (UHC) recently announced it will begin requiring prior authorization for certain gastroenterology endoscopy services for commercial plan members effective June 1, 2023.  Included in the new prior authorization requirements are the following procedures:

  • Esophagogastroduodenoscopies
  • Capsule endoscopies
  • Diagnostic colonoscopies
  • Surveillance colonoscopies

(Screening colonoscopy procedures are not included in this new prior authorization requirement. )

The California Medical Association (CMA) is concerned that this new prior authorization requirement is yet another unnecessary, administrative burden that will simply delay patient access to medically necessary diagnostic services. 

For more information about about how this change may affect physicians, UHC has published answers to frequently asked questions.  For additional questions or concerns regarding this process, contact UHC Provider Services at (866) 416-6594.

Share Your Story

When insurance companies get between patients and physicians, patients get sicker and health care becomes more expensive. CMA is sponsoring legislation to reform the prior authorization process, which will result in less time spent on administrative work, increased access to necessary care for patients and a restoration of the physician-patient relationship in medical decision-making.

CMA is encouraging physicians whose practices and patients have been negatively impacted by prior authorization to share their stories. By adding your voice to the call for prior authorization reform, you can help ensure that patients receive the care they need — when they need it.




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