UnitedHealthcare has revised its plans for a controversial gastroenterology endoscopy prior authorization policy. Instead, they have implemented an advance notification policy for non-screening and non-emergent GI procedures. This new policy, effective immediately, will collect data to expedite the launch of the gold-card program for GI physician groups in 2024. UnitedHealthcare is considering additional notification or prior authorization for physicians who don’t qualify for the gold-card program. During the advance notification period, they will engage in comprehensive peer-to-peer discussions rather than issuing medical denials.
UnitedHealthcare has altered its plans to implement a controversial gastroenterology endoscopy prior authorization policy, opting instead for an advance notification policy for non-screening and nonemergent GI procedures. Here are seven important details shared by UnitedHealthcare regarding the new policy:
1. Immediate Effect: The advance notification requirement applies to non-screening colonoscopies, esophagogastroduodenoscopies, and capsule endoscopies for surveillance and diagnostic purposes.
2. Duration: The advance notification process will remain in place until UnitedHealthcare’s gold-card program launches in early 2024.
3. Data Collection: UnitedHealthcare stated that the advanced notification system will enable them to gather the necessary data to expedite the implementation of the gold-card program for GI physician groups in 2024.
4. Additional Authorization: The decision to pursue additional notification or potential prior authorization for physicians who do not qualify for the gold-card program is yet to be determined by UnitedHealthcare.
5. Rolling Admission: Provider groups that do not initially meet the caseload threshold may be granted rolling admission into the gold-card program as their case volume increases.
6. Eligibility Criteria: Provider groups failing to submit advance notifications during this period will not be considered for the gold-card program.
7. Comprehensive Discussions: During the advance notification period, UnitedHealthcare will engage in comprehensive peer-to-peer discussions with board-certified gastroenterologists for procedures that are not aligned with clinical evidence instead of issuing medical denials.
These updates from UnitedHealthcare reflect adjustments to their policy, aiming to strike a balance between efficient management of GI procedures and ensuring appropriate care based on clinical evidence.
