I recently received the UnitedHealthcare Network Bulletin for February. It highlighted several new authorization policies that effect high cost 
treatments like chemotherapy and radiation oncology.
All the radiation oncology medical billers have been trying to get their head around the coding changes implemented by CMS and the AMA that took effect January 1, 2015.
Go our medical billing blog to look for guides and articles that can help you to transition into the new codes.
It is not news that IMRT requires authorization for UHC members of these plans: UnitedHealthcare, UnitedHealthcare West, UnitedHealthcare of the Mid-Atlantic, UnitedHealthcare Plan of the River Valley, and Neighborhood Health Partnership.
You do however need to update the fax cover sheet request form you have been using to the 2015 version. Access the new form at: UnitedHealthcareOnline.com> Clinician Resources > Oncology > Intensity Modulated Radiation Therapy > Related Links.
You can request the authorization online as well.
You can rest easy though if you have an existing IMRT authorization that was issued in 2014 for CPT codes 77418 or 0073T. UHC has implemented a code crosswalk that will process your claims for the new codes (77385, 77386, G6015, G6016) under those prior authorizations.
Iridium Suite medical billing software contains an authorization scrubber that prevents you from submitting claims without a required authorization.
Get ready for the June 1, 2015 changes for outpatient injectable chemotherapy effecting: UnitedHealthcare Fully Insured and select ASO membership. CareCore National will be managing these authorizations and can be obtained via their website. Any treatments that follow the standard National Comprehensive Cancer Network (NCCN) protocol will receive immediate authorizations. For pediatric chemotherapy regimens, rare cancers, or chemotherapy regimens that are not NCCN-recommended, documentation will be required in order to fully process the request.
If you want more information, sign up in April for their online seminar: UnitedHealthcareOnline.com> Clinician Resources > Cancer – Oncology > Chemotherapy Prior Authorization Program.
Besides obtaining treatment authorizations for your cancer patients, often you are tasked with getting the payer’s approval for advance diagnostic imaging services. UHC had announced in the fall of 2014 that they would be adding authorization requirements for members of the UHC River Valley and River Valley Entities Supplement plans.
In this new February newsletter, UHC states they have run out of time to get this new authorization policy in place. They will be delayed indefinitely. It would have affected Computerized Tomography (CT), Magnetic Resonance Imaging (MRI), Magnetic Resonance Angiography (MRA), Positron-Emission Tomography (PET), Nuclear Medicine and Nuclear Cardiology.
