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UHC Changes Authorization Requirements

John Spiezio

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:



United Healthcare Letters to Providers:


January 2025: effective January 13, 2025:




August 2024: effective September 1, 2024 (expired):




 



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!


Contact SMBS at:

tel: 631-343-3147

The Outpatient Rehabilitation Practice Management and Billing Specialists!
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