service, e.g. type of provider, site of care, etc. Identify if/what supporting Supporting documentation documentation that needs to be sent requirements are not identified on the with a review request, including site. documentation for Unlisted Procedures Identify clinical criteria Met Medical policies are difficult to find unless you are an experienced user. (They are under Tools and Resources rather than Clinician Resources) See website#10 comment Identify whether approval of this service is dependent upon previously trying other services, i.e. and failed”. “tried Provide an online form/web page Met Steps – for requesting pre-service review Many providers don’t initiate the On form/web page - Allow Services requiring an urgent review submission process unless clinical specification of the of the can’t be requested online. There is a “urgency” documentation is complete and request highlighted note on the request page available to administrative that indicates that UHC needs to be Otherwise there is a risk of denial if called for urgent requests. the clinicals can’t be faxed in two Identify the time frame under which Submitting days. the request will be reviewed, Review Request somewhere in the process Select Notification ‘Radiology …’ On form/web page - Allow A separate request needs to be entries in Prior ‘Notifications/ specification of ALL the submitted for each CPT code. Met Authorizations’ drop down services/medication/administration Enter required information into to be reviewed See website #8b comment. UHC site On form/web page - Include There are no site of service questions about any relevant restrictions on any imaging services
service, e.g. type of provider, site of care, etc. Identify if/what supporting documentation that needs to be sent with a review request, including documentation for Unlisted Procedures Supporting documentation requirements are not identified on the site. Identify clinical criteria Met Medical policies are difficult to find unless you are an experienced user. (They are under Tools and Resources rather than Clinician Resources) See website#10 comment Identify whether approval of this service is dependent upon previously trying other services, i.e. “tried and failed”. Submitting Review Request Steps – Many providers don’t initiate the submission process unless clinical documentation is complete and available to administrative Otherwise there is a risk of denial if the clinicals can’t be faxed in two days. Select ‘Radiology Notification …’ entries in ‘Notifications/ Prior Authorizations’ drop down Enter required information into UHC site Provide an online form/web page for requesting pre-service review Met On form/web page - Allow specification of the “urgency” of the request Services requiring an urgent review can’t be requested online. There is a highlighted note on the request page that indicates that UHC needs to be called for urgent requests. Identify the time frame under which the request will be reviewed, somewhere in the process On form/web page - Allow specification of ALL the services/medication/administration to be reviewed Met A separate request needs to be submitted for each CPT code. See website #8b comment. On form/web page - Include questions about any relevant There are no site of service restrictions on any imaging services
UHC-CP%20Detail%201.docx