July 01, 2024
Michigan: Prior authorization updates for provider administered medications
Beginning Oct. 1, 2024, we will require prior authorization and notification for certain provider administered medications for UnitedHealthcare Community Plan members in Michigan. If we don’t receive a prior authorization request before the date of service, we’ll deny the claim and you won’t be able to balance bill members.
View the list of impacted drugs and their HCPCS codes in the table below.
| Drug name | HCPCS code |
|---|---|
| Briumvi® | J2329 |
| Corticotropin Gel® | J0802 |
| Daxxify® | J0589 |
| Eylea® HD | J0177 |
| Izervay™ | J2782 |
| Leqembi® | J0174 |
| Panzyga® | J1576 |
| Pombiliti™ | J1203 |
| Qalsody® | J1304 |
| Rystiggo® | J9333 |
| Syfovre® | J2781 |
| Tzield® | J9381 |
| Veopoz® | J9376 |
| Vyjuvek® | J3401 |
| Vyvgart® Hytrulo | J9334 |
How to submit a request
You can submit a prior authorization request through the UnitedHealthcare Provider Portal:
- Go to UHCprovider.com and click Sign In at the top-right corner
- Enter your One Healthcare ID and password
- New users who don’t have a One Healthcare ID: Visit UHCprovider.com/access to get started
- In the menu, select Prior Authorizations
- Scroll down to “Create a new notification or prior authorization request” and select Specialty Pharmacy from the dropdown menu
- Enter the required information and submit
Questions?
For contact information, visit our Contact us page. For questions about the prior authorization process, call 888-397-8129.
PCA-1-24-01777-Clinical-NN_06132024
