Re: Expansion of outpatient radiology prior authorization requirements for AmeriChoice by UnitedHealthcare effective February 15, 2010
Dear Physician, Facility, or Other Health Care Professional:
UnitedHealthcare and its family of companies are working together to simplify our processes and your interactions with us. We value our relationship with you, and we appreciate the care you provide to the people we insure. As you are aware, we are committed to ensuring effective use of imaging services and addressing preventable radiation exposure. Recent published literature, as well as concerns expressed by expert external scientific advisors, indicates that advanced imaging procedures are a major and growing source of ionizing radiation in the U.S. and can result in high cumulative levels of radiation for patients. In addition, significant variations exist in the quality, safety and appropriate utilization of imaging services in health care delivery.
As such, we are expanding the scope of our radiology prior authorization requirements for AmeriChoice. Effective February 15, 2010 we will require all physicians to contact us prior to performing select advanced imaging procedures rendered to our AmeriChoice members.
Previously, you may have received communications from UnitedHealthcare regarding augmentation to the UnitedHealthcare Radiology Notification Program. Consistent with our effort to minimize administrative inconvenience for the physicians who participate in our networks, we have worked to align our program supporting AmeriChoice to be as similar as possible to the Commercial program, within the constraints of benefit design and other considerations. While essentially the same as our Commercial program, there are some variations in the process due to nuances in the plans administered by AmeriChoice. However, these prior authorization requirements do not change the Outpatient Radiology Notification protocol for patients enrolled in our Commercial programs and products.
In alignment with our Commercial program, the following outpatient advanced imaging procedures, CT scans, MRIs, MRAs, PET scans and select nuclear medicine studies, including nuclear cardiology are subject to this new prior authorization protocol for the following plans managed by AmeriChoice:
- TennCare
- Secure Plus Complete
As with the Radiology Notification Program, advanced imaging services that take place in an emergency room, observation unit, urgent care facility or during an inpatient stay DO NOT require prior authorization.
In order to promote consistent treatment practices and improved care for both Commercial and AmeriChoice members, similar clinical and evidence based guidelines will be used to the extent possible, allowing for any special requirements from AmeriChoice’s coverage determination policies.
In 2010, we will continue our work to align our radiology programs for Commercial, Medicaid and Medicare Advantage members to achieve enhanced operational consistency. Further details will be shared with you prior to implementation.
Prior Authorization Process
Beginning February 1, 2010, prior authorization will be required from the ordering physician’s office for select outpatient radiology services for dates of service on or after February 15, 2010.
To maximize administrative efficiency for physicians who participate in our networks, we will employ the same telephone numbers to obtain prior authorization as we do today for the current Radiology Notification program.
- By calling toll-free 866-889-8054, or
- Faxing to 866-889-8061, or
- Online at www.americhoice.com
A copy of the Frequently Asked Questions (FAQ) document is enclosed in this mailing for your convenience. This document, along with the complete list of procedure codes that will require prior authorization, are posted on the AmeriChoice’s physician web site at www.americhoice.com.
We appreciate your participation with AmeriChoice. If you have prior authorization questions, please contact your AmeriChoice Network Management representative, or call 800-690-1606.
Sincerely,
Mark Mahler, MD Chief Medical Officer
Enclosures