New requirements effective January 13, 2025

Changes to UHC and AARP
Medicare Advantage Plans
Clinical Submission Requirements for
Physical Therapy, Chiropractic, Occupational and Speech Therapy Service
United Healthcare has recently announced changes to the pre-authorization requirements for all of their Medicare Advantage Plans, effective January 13th, 2025 (previous update was September 1, 2024 and is now replaced with the new requirements.)

UHC Medicare Advantage Pre-Authorization Requirements
effective January 13, 2025
The first 6 visits of a patient's POC are covered within the first 8 weeks of care
New patient to your office, or returning patient with a new condition
Patient has a gap in care of 90 or more days
Care plans of more than 6 visits or in excess of 8 weeks requires a pre-authorization
Patients under a POC prior to January 13th, 2025 must have continuous pre-authorizations as required by the September 1, 2024 requirements
Reminder... UHC requirements in effect as of September 1, 2024 requires a pre-authorization for all visits after the Initial Evaluation for all UHC Medicare Advantage Plans.
United Healthcare Complete Guidance:
UHC pre-authorization requirements can be found on the UHC page at the following link (see the links at the bottom of the page under the heading "Medicare Advantage Prior Authorization Outpatient Therapy Resources"):
Clinical review and acquisition of pre-authorizations are handled through the same portal:
United Healthcare Letters to Providers:
January 2025: effective January 13, 2025:
August 2024: effective September 1, 2024 (expired):
Let us provide your SOUND MEDICAL BILLING SOLUTIONS!
John Spiezio, President
Sound Medical Billing Solutions, LLC
Call, click or email for more information about this or any other topic that my affect your practice. We will be happy to help!

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