{"id":8811,"date":"2023-06-05T09:14:39","date_gmt":"2023-06-05T09:14:39","guid":{"rendered":"https:\/\/distilinfo.com\/healthplan\/?p=8811"},"modified":"2023-06-05T09:14:39","modified_gmt":"2023-06-05T09:14:39","slug":"unitedhealthcare-revises-gi-procedure-policy-7-key-details","status":"publish","type":"post","link":"https:\/\/distilinfo.com\/healthplan\/unitedhealthcare-revises-gi-procedure-policy-7-key-details\/","title":{"rendered":"UnitedHealthcare Revises GI Procedure Policy: 7 Key Details"},"content":{"rendered":"<blockquote><p>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&#8217;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.<\/p><\/blockquote>\n<p>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:<\/p>\n<p>1. Immediate Effect: The advance notification requirement applies to non-screening colonoscopies, esophagogastroduodenoscopies, and capsule endoscopies for surveillance and diagnostic purposes.<\/p>\n<p>2. Duration: The advance notification process will remain in place until UnitedHealthcare&#8217;s gold-card program launches in early 2024.<\/p>\n<p>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.<\/p>\n<p>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.<\/p>\n<p>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.<\/p>\n<p>6. Eligibility Criteria: Provider groups failing to submit advance notifications during this period will not be considered for the gold-card program.<\/p>\n<p>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.<\/p>\n<p>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.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>UnitedHealthcare has revised its plans for a controversial gastroenterology endoscopy prior authorization policy. Instead, they have implemented an advance notification&#8230; <a href=\"https:\/\/distilinfo.com\/healthplan\/unitedhealthcare-revises-gi-procedure-policy-7-key-details\/\" style=\"white-space: nowrap;\">Continue Reading <i class=\"fas fa-long-arrow-alt-right\" style=\"vertical-align: middle;\"><\/i><\/a><\/p>\n","protected":false},"author":1,"featured_media":8812,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_genesis_hide_title":false,"_genesis_hide_breadcrumbs":false,"_genesis_hide_singular_image":false,"_genesis_hide_footer_widgets":false,"_genesis_custom_body_class":"","_genesis_custom_post_class":"","_genesis_layout":"","footnotes":""},"categories":[1],"tags":[],"class_list":{"0":"post-8811","1":"post","2":"type-post","3":"status-publish","4":"format-standard","5":"has-post-thumbnail","7":"category-distilinfo-originals","8":"entry"},"_links":{"self":[{"href":"https:\/\/distilinfo.com\/healthplan\/wp-json\/wp\/v2\/posts\/8811"}],"collection":[{"href":"https:\/\/distilinfo.com\/healthplan\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/distilinfo.com\/healthplan\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/distilinfo.com\/healthplan\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/distilinfo.com\/healthplan\/wp-json\/wp\/v2\/comments?post=8811"}],"version-history":[{"count":1,"href":"https:\/\/distilinfo.com\/healthplan\/wp-json\/wp\/v2\/posts\/8811\/revisions"}],"predecessor-version":[{"id":8813,"href":"https:\/\/distilinfo.com\/healthplan\/wp-json\/wp\/v2\/posts\/8811\/revisions\/8813"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/distilinfo.com\/healthplan\/wp-json\/wp\/v2\/media\/8812"}],"wp:attachment":[{"href":"https:\/\/distilinfo.com\/healthplan\/wp-json\/wp\/v2\/media?parent=8811"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/distilinfo.com\/healthplan\/wp-json\/wp\/v2\/categories?post=8811"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/distilinfo.com\/healthplan\/wp-json\/wp\/v2\/tags?post=8811"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}