United Healthcare (UHC) on October 18 provided further guidance on its controversial implementation of a new prior authorization (PA) requirement for physical, occupational, speech therapies and Medicare-covered chiropractic services in its many of its Medicare Advantage products. UHC announced its its PA requirement intentions in August 2024 with a September 1 start date.
While the original notice indicated that these new requirements did not apply to therapies provided by skilled nursing facilities and home health agencies, confusion remained as UHC provider service representatives told these providers they needed to comply. The new memo provides new clarifications that for SNFs, it is the bill type that indicates whether a prior authorization is required. For example, no prior authorization would be required for bill types 22X and 24 X, for example, for a Part B nursing home. It also restates that the prior authorization requirements do not apply to out of network providers, nor enrollees in certain UHC plans like their United Healthcare Dual Complete.
Members should review both the original and the new memo if they have questions, and reach out to United Healthcare Provider Services at 877-842-3210 if they have specific situations for which they are unclear whether this prior authorization requirement applies.
