UnitedHealthcare Makes it Easier and Quicker for Children to Get Care for 2,000 Pediatric Care Services

Changes take effect Dec. 1 and deliver on a promise to cut nearly 2/3 of pediatric prior authorizations

--(BUSINESS WIRE)--Beginning Dec. 1, children covered by UnitedHealthcare will no longer need prior authorization for more than 2,000 pediatric care codes spanning common services, diagnostic imaging, sleep studies, cancer treatment and orthopedic care.

Examples include ear tube and tonsil procedures, sleep studies, MRI and CT scans, joint procedures, cardiac procedures, and some oncology and chemotherapy services.

UnitedHealthcare chose to fast-track services that are widely considered in the medical community to be safe and effective, resulting in a nearly two-thirds reduction of prior authorization volume. As a result, clinicians, families and caregivers will be able to spend more time focused on patients.

“Every child deserves a health care experience centered on their needs,” said Tim Noel, CEO of UnitedHealthcare. “These changes will help make that experience simpler for children, their families and the physicians who care for them.”

Today, UnitedHealthcare published the full list of more than 2,000 distinct CPT^® codes that will no longer require prior authorization for patients under age 18. The publication follows UnitedHealthcare’s May commitment to eliminate nearly two-thirds of pediatric prior authorization requirements and gives care providers information to prepare for the changes.

Select complex services will still need prior authorization, such as certain injectable medications, genetic tests, surgical procedures, and those that are required to be managed by state regulations.

The changes announced today apply to UnitedHealthcare commercial plans, UnitedHealthcare Individual Exchange Plans and UnitedHealthcare Community Plans, where permissible by state law. For eligible UnitedHealthcare members, the changes aren’t limited to care delivered at specific pediatric facilities. Some pediatric services will continue to require advance notification.

Providers should review the applicable CPT^® code list and use the Prior Authorization and Notification tool on the UnitedHealthcare Provider Portal to verify requirements for a specific service, member and plan.

Continuing Efforts to Simplify Prior Authorization

Today’s announcement builds on UnitedHealthcare’s broader efforts to simplify and modernize prior authorization and improve the health care experience for providers and patients, including:

• Reducing approximately 30% of total prior authorization volume

• Expanding the UnitedHealthcare Gold Card program, which reduces prior authorization requirements for provider groups that consistently adhere to evidence-based care guidelines

• Supporting rural hospitals and care providers through initiatives that reduce administrative friction, accelerate payments and support access to care

• Advancing industrywide standardization of electronic prior authorization submission requirements to improve interoperability and create a more seamless care experience

Together, these efforts reflect UnitedHealthcare’s continued focus on reducing administrative complexity, improving the care experience and helping people access care more easily and efficiently.

About UnitedHealthcare

UnitedHealthcare is dedicated to helping people live healthier lives and making the health system work better for everyone by simplifying the health care experience, meeting consumer health and wellness needs, and sustaining trusted relationships with care providers. The company offers the full spectrum of health benefit programs for individuals, employers, and Medicare and Medicaid beneficiaries, and contracts directly with physicians, care professionals, hospitals and other care facilities. UnitedHealthcare is one of the businesses of UnitedHealth Group (NYSE: UNH), a diversified health care company. For more information, visit UnitedHealthcare at www.uhc.com or follow UnitedHealthcare on LinkedIn.