Starting in 2019, Optum will start managing the online request process for outpatient therapeutic radiopharmaceuticals. This change will apply to UnitedHealthcare commercial plan members effective April 1, 2019 and for select Community & State members effective May 1, 2019. As an affiliate of UnitedHealthcare, Optum offers solutions to help improve the care provider experience for transactions such as prior authorization requests.
Now, when you use the Prior Authorization and Notification tool to submit your prior authorization request, you’ll click on Oncology and enter the member’s state and product details as prompted. You’ll be directed to the Optum website to complete your request.
To help ensure our member benefit coverage is medically appropriate, we regularly evaluate our medical policies, clinical programs and health benefits based on the latest scientific evidence and specialty society guidance. To support these goals, we require notification/prior authorization for therapeutic radiopharmaceuticals administered to UnitedHealthcare commercial plan members in an outpatient setting.
For more information about UnitedHealthcare commercial plan policies, go to UHCprovider.com/policies > Commercial Policies.
Prior authorization is required for the following:
Therapeutic radiopharmaceuticals billed under the following HCPCS codes require prior authorization:
Please complete all prior authorization requests online. The online system will identify the members who need a prior authorization request submitted. To learn more about using Link to request prior authorization, go to UHCprovider.com/paan. If you have questions, please call 888-397-8129, 8 a.m. to 5 p.m. local time, Monday through Friday.
The following UnitedHealthcare Commercial plans require prior authorization for therapeutic radiopharmaceuticals:
The following UnitedHealthcare Community & State plans require prior authorization for therapeutic radiopharmaceuticals:
If you have questions, please email unitedoncology@uhc.com.
Footnotes
On April 1, 2019, Optum will start managing the online request process for outpatient therapeutic radiopharmaceuticals. This change will apply to UnitedHealthcare commercial plan members. As an affiliate of UnitedHealthcare, Optum offers solutions to help improve the care provider experience for transactions such as prior authorization requests.
Now, when you use the Prior Authorization and Notification tool to submit your prior authorization request, you’ll click on Oncology and enter the member’s state and product details as prompted. You’ll be directed to the Optum website to complete your request.