Expansion of Radiology and Cardiology Notification/Prior Authorization Protocols to All Savers Plans (Offered Off-exchange) – Effective April 1, 2017

Effective April 1, 2017, care providers must provide notification prior to scheduling a planned service that is subject to UnitedHealthcare’s Outpatient Radiology Notification/Prior Authorization Protocol and Cardiology Notification/Prior Authorization Protocols for a UnitedHealthcare All Savers (offered off-exchange) member. These members can be identified by their ID cards. These protocols include a prior authorization requirement that applies when a UnitedHealthcare member’s benefit document requires health services to be medically necessary to be covered. Once notification has been received, UHC will conduct a clinical coverage review if the member’s benefit document requires health services to be medically necessary to be covered.

Source: https://www.unitedhealthcareonline.com/ccmcontent/ProviderII/UHC/en-US/Assets/ProviderStaticFiles/ProviderStaticFilesPdf/News/January-2017-Network-Bulletin.pdf