Medicaid: Prior authorization required for all shoulder surgery service codes beginning Aug. 1, 2022
Effective Aug. 1, 2022, we will require prior authorization for all shoulder surgery service codes for UnitedHealthcare Community and State health plan members.
Prior authorization is not required for emergency or urgent services
We will deny claims if prior authorization is not on file before the date of service
Included states The prior authorization requirement will be deployed on Aug. 1, 2022, for the following state plans:
The prior authorization requirement will be deployed on Sept. 1, 2022, for the following state plans:
Medical necessity review
When you submit a prior authorization request starting Aug. 1, 2022, we will review your request for medical necessity. We will provide an authorization, if appropriate, and send that determination to you and your patient.
A site of service review may be performed when the case is reviewed to determine if the location where the services will be performed is medically necessary.