11/18/2020

Managed Care Committee Reimbursement TIDBITS

Featuring this month: UnitedHealthcare

TidBits thanks to

SHELBY JENSEN

MSHO Managed Care Committee

Did you know.... Network Bulletin PDF Format Retiring

Starting Jan. 1, 2021, the Network Bulletin PDF format will be retired. You’ll continue to have access to all your notices and updates online at UHCprovider.com/networknews. This fully digital experience allows you to view the news most relevant to you. And, you can easily print and share individual articles as needed.  You can sign up to receive monthly email updates at UHCprovider.com/subscribe.

Did you know.... Prior Authorization and Notification Requirement Updates

View the Updated Notice of Changes to Plan Requirements to get the latest updates to our advance notification and prior authorization requirements. The bulletin is available at UHCprovider.com/priorauth > Advance Notification and Plan Requirement Resources > 2020 Summary of Changes.

To see current prior authorization requirements for all plans, please visit UHCprovider.com/priorauth > Advance Notification and Plan Requirement Resources > Select a Plan Type.

Did you know.... Leuprolide Acetate Requires Prior Authorization

On Feb. 1, 2021, we will begin requiring prior authorization for leuprolide acetate (HCPCS code J1950) for commercial plan members.

If the member received leuprolide acetate in an outpatient setting from Nov. 1, 2020, through Jan. 31, 2021, you don’t need to submit a prior authorization request. The prior authorization coverage of leuprolide acetate, which the member was receiving prior to Feb. 1, 2021, will be effective through Jan. 31, 2022.

How to Submit Prior Authorization

• Sign in to Link using your Optum ID and select the Prior Authorization and Notification tool.
• If you don’t have an Optum ID, you can register today.

Please complete all notifications online. If you have questions or need assistance with your online request, call 888-397-8129, 8 a.m. – 5 p.m., Monday – Friday local time.

Questions? Please visit Prior Authorization for Chemotherapy and Related Cancer Therapies.

NOTE: A different Michigan Payer will be featured monthly.

 Visit the MSHO Website for a listing of the Michigan Health Plans and the MSHO Managed Care Committee.

CLICK HERE