Thanks to feedback from providers like you, UnitedHealthcare has made important updates to its prior authorization requirements for therapy and chiropractic services under the Medicare Advantage Individual and Group Retiree plans.
Here's What We Know:
- Starting January 13, 2025, providers will no longer need prior authorization for the first 6 visits of a care plan, provided those visits occur within an 8-week period.
- This change is a significant step forward, allowing you to focus on patient care by beginning treatment promptly and ensuring timely follow-up without delays.
- Additional Questions? Providers can call 800-873-4575.
- OptumCare and WellMed contracted providers: Please refer to the number on the member ID card for prior authorization instructions.
Providers must continue to submit a prior authorization request for the entire plan of care, including the full duration and number of visits requested. However, for new authorization requests starting on or after Jan. 13, 2025, up to the first 6 visits of a member’s initial plan of care will be covered without conducting a clinical review when the first 6 visits take place within 8 weeks of the first date of service.
Only care plans requesting more than 6 visits or care plans exceeding 8 weeks will be assessed for medical necessity. The initial consultation/evaluation still does not require prior authorization.
Resources:
- Medicare Advantage: Prior authorization resources for outpatient therapy and chiropractic services
- Information on How to Submit
Thank you for your input and for contacting the WCA and Optum/United Healthcare with your concerns.