New UnitedHealthCare Preauthorization Requirements Set to Kick-in July 1

Starting on July 1, UnitedHealthcare (UHC) will begin requiring preauthorization for their Commercial Plans for the following cardiovascular procedures: echocardiography, stress echocardiography, electrophysiologic implant devices, and diagnostic cardiac catheterization. Currently, UHC mandates preauthorization for these procedures for the payer’s Medicare Advantage plans. Pre-authorization can be obtained through its vendor, CareCore National.  UHC will not reimburse for any service not pre-authorized.
UHC will also change its existing pre-notification obligation to pre-authorization on July 1. This change will allow UHC through CareCore to deny authorization requests not meeting the UHC/CareCore clinical criteria and will impact nuclear cardiology, CT, MR and PET requests. To review the UHC notice and program terms, click here.

The ACC is dedicated to ensuring practice guidelines and AUC developed by the College are implemented consistently across-the-board while leaving the final testing and treatment decisions to the treating physician. The College will continue to urge UHC and other payers to use these documents to determine consistent medical coverage. If you and your practice are experiencing difficulties and inappropriate pre-authorization denials, contact ACC Advocacy for assistance.

Clinical Topics: Noninvasive Imaging, Echocardiography/Ultrasound

Keywords: Echocardiography, Stress, Cardiac Catheterization, Electrophysiological Phenomena, United States, Echocardiography

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