UHC Provides More Prior Authorization Information
As a reminder, effective September 1, 2024, UnitedHealthcare (UHC) implemented a new prior authorization requirement for chiropractic services for Medicare Advantage members. The Illinois Chiropractic Society (ICS) objected in a written letter to UHC/Optum’s CEO of Medicare and urged the company to rescind the new policy. We believe that these requirements only serve to delay access to care and increase administrative burdens for clinicians. We continue to work tirelessly, in partnership with other state and national chiropractic organizations, to advocate for changes to these prior authorization requirements.
We have not received a response. However, last week, UHC released clarifications on their prior authorization requirements and process. You can find the updated information here. This clarification clearly excludes out-of-network providers and lists specific plans that are not included in the new requirement.
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The update also provides more specific information on the location codes (including your office) that will require prior authorization. Lastly, they clarify that authorization is required prior to billing and that the “Clinical Submission Number or Service Reference Number (SRN#) is acceptable to submit on the claim form.”
IMPORTANT: We continue to strongly urge doctors to provide patients with the patient flyer explaining the potential negative impact prior authorization requirements have on their coverage and their health. We believe that patient engagement is helpful in advocating on this issue. You can download the patient flyer here.
Please use this updated version of the flyer, as a previous version referenced Humana which now no longer impacts Illinois chiropractic physicians.
The new UHC release provides the following steps for completing the Prior Authorization requirement:
“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 prior authorization submission,” click “Select prior authorization type for submission” and then select “Physical Health”
- Next click “Select plan type,” select “Medicare” and click “Continue”
- Enter the required information and submit
If we don’t receive a prior authorization request within 10 days after starting the service, we may deny the claim, and you won’t be able to balance bill members.”
The Illinois Chiropractic Society will continue to advocate for our doctors and patients and will keep our members updated on this ongoing issue.
