Starting Feb. 15, all physicians in UnitedHealthcare's Premium Quality and Cost Efficiency program must give United prior notice [ PDF ] before ordering outpatient imaging procedures. The change applies to CT scans, MRIs, MRAs, PET scans, and nuclear medicine studies, including nuclear cardiology.
Previously, physicians in the premium program were exempt from the notification requirement.
TMA views the notification requirement as preauthorization, but the Texas Department of Insurance says it is not, because the program does not deny a request for imaging services.
United says the decision to include all network physicians, including Premium Quality and Cost Efficiency designated physicians, in the notification program "is based on UnitedHealthcare's concern for patients who are subject to preventable radiation exposure, as well as direct feedback from practicing physicians and office managers, who, while appreciating the exemption for UnitedHealth Premium ® designated physicians, have also reported additional administrative complexity in managing these exemptions. Consequently, UnitedHealthcare will streamline and simplify the program for all stakeholders by having the same administrative requirements for all physicians."
Physicians ordering advanced imaging services should complete prior notification online or call (866) 889-8054.
Advanced imaging services in emergency rooms, observation units, or urgent care facilities, or during an inpatient stay do not require prior authorization, United says.
Action , Feb. 1, 2010