UHC: Extensions of Existing Prior Authorizations
The following prior authorization provisions apply to all Individual and Group Market health plans, and Medicaid and Medicare Advantage plans.
A 90-day extension, based on original authorization date, of open and approved prior authorizations with an end date or date of service between March 24, 2020 and May 31, 2020, for services at any care provider setting. For example, for a prior authorization with an original end date or date of service of April 30, 2020, the prior authorization would now extend through July 29, 2020.
Applies to existing prior authorizations for medical, behavioral health and dental services. This includes existing prior authorizations for many provider-administered drugs.
Authorizations issued on or after April 10, 2020 will not be subject to extension.
Applies to in-network and out-of-network existing prior authorizations.
Prior authorizations for inpatient procedures will extend 90 days from the expected admission date.
Providers should re-confirm member eligibility before providing services, when authorized dates of service are extended, to help ensure that accurate coverage and benefits are applied.
If a prior authorization approves the number of visits or services, then providers must obtain a new prior authorization for additional units, visits or services beyond what was approved in the original authorization.
For example, if the original authorization approved 10 sessions of physical therapy, any sessions beyond 10 would require a new authorization.
UnitedHealthcare will also follow related state mandates where applicable. However, when UnitedHealthcare provisions exceed those required by states, UnitedHealthcare provisions will apply.
For example, if a state has mandated an extension of prior authorizations by 60 days and UnitedHealthcare has extended prior authorizations by 90 days, we will apply the 90-day time frame to the extension.
Providers can check the status of authorizations by using either the Prior Authorization and Notification tool on LinkOpens in a new window or by visiting the website listed on the back of the member’s ID card.