UnitedHealthcare Optum Healthcare Solutions to Require Prior Authorization
UnitedHealthcare (UHC) Optum Healthcare Solutions will begin to require prior authorization for follow-up outpatient therapy visits for certain plans. In this article, I will answer the following questions:
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Can we submit Outcome Measures (Quick Dash, etc..) that are obtained in the Initial Evaluation vs double work with paper questionnaires before the Evaluation as well for scoring submission to UHC?
Have you seen the form and information Optom UHC is requiring the therapist and patient to complete and submit to get visits approved.
This is going to delay care and increase the resources necessary to get authorization . We Will need to hire at least a full time person to manage this process.
This UHC process is already causing a major backlog with Patients being unable to get approval for visits. UHC Optum have provide no resources to education providers. The process requires the therapists and or Patient to compete a 3 page request document on their portal.. The delay in authorizations is exceeding 2 an estimated 2 weeks. AS a provider it will require additional office staff just top address these authorizations. Have you guys looked at providing resources to traain on this process? UHC Optum obviously are trying to limit the therapy visits.
Optum’s authorization process is not designed for office staff to request the authorization. It is requesting information that the therapist and patient should be completing. All of the authorizations I have submitted with documentation (scripts, PN or IE, DASH, etc) have been given minimal approved visits. Example: All my notes submitted request 12 and the authorization only allows 4. I have a patient who had major surgery and is in a sling for 8 weeks and is only being allowed a total of 16 visits! If I had a UHC Medicare Replacement plan, I would look at changing to a new plan for 2025. UHC should possibly look into using Cohere for authorization. It more user friendly and easier for the office staff to process a request for authorization.
This should come as no surprise to anyone. What we all need to do is to educate Medicare beneficiaries about the main access to all services, especially physician and outpatient, and how traditional Medicare is better than Medicare Advantage. If Medicare beneficiaries have the financial resources to afford the Medigap plans, need to educate them to the benefits of choosing traditional Medicare.
We have the Therapist completing the UHC form and the Admin staff are transfering that info to the UHC/Optum portal. They also are delaying the start of care by delaying approval. They need a pathway in the process for urgent cases i.e. any post op patient. Early intervention for surgical patients is critical for outcomes.
The real issue is that UHC has provided no education that we can ID.
The advantage plans should not be allowed to require more elements to the authorization process than regular MC.
Does this apply to both in and out of network providers?
New information that at least 2 UHC provider reps are advising is that this is a Physician issue. They are suggesting that the Physicians should be the ones getting the prior authorizations. I don’t think this is accurate information however we can’t get anyone to validate this process. Has anyone else heard this?
I would agree that it is not the physician.