The nation’s largest commercial insurer is initiating new prior authorization restrictions this month, the American College of Radiology warned members on Thursday.
Beginning April 1, UnitedHealthcare is making physicians jump through extra hoops to obtain payment for certain outpatient services. That includes imaging-guided radiation therapy along with fractionation for breast, prostate, lung and bone metastasis cancers. UHC will deny claims from practices that fail to obtain prior authorization in such instances.
“American College of Radiology staff will continue to monitor these new requirements and seek opportunities to alleviate unnecessary burdens to practices and centers offering radiation therapy services,” ACR said in an update posted April 1. “Providers offering radiation therapy services should share this information with your billing staff to ensure they have the latest information,” it added later.
Those seeking further information can read this frequently asked questions document from UHC, attend a provider training web event slated for today at 11 a.m. Central Time, or email the insurance giant at unitedoncology@uhc.com.
Here’s the full list of services added to the list alongside intensity-modulated radiation therapy and proton beam therapy, which already require PA:
- Stereotactic body radiation therapy, including stereotactic radiosurgery.
- Fractionation for breast, prostate, lung and bone metastasis cancers.
- Image-guided radiation therapy.
- Special and associated radiation therapy services. Selective internal radiation therapy, Yttrium 90 and implantable beta-emitting microspheres for treatment of malignant tumors.
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.