Beginning with dates of service on or after Jan. 1, 2019, UnitedHealthcare, aiming to minimize out-of-pocket costs for its members, will review the site of care during their Outpatient Radiology Prior Authorization process. This is being instituted, many believe, to allow UHC to direct patients away from outpatient hospital settings and into outpatient freestanding imaging facilities where prices can be up to 50% less expensive for the carrier.
Beginning with dates of service on or after Jan. 1, 2019, once prior authorization is requested for certain advanced outpatient imaging procedures (CT and MR) in accordance with its Outpatient Radiology Notification/Prior Authorization Protocol, UHC will review the site of care. UHC will not conduct site of care reviews if the procedure is planned to be performed in a outpatient freestanding imaging facility or an office setting.
Site of care reviews will apply to providers in all states, except Iowa, Kentucky and Utah. Site of Care reviews will apply to UnitedHealthcare commercial benefit plans, including exchange benefit plans and the following benefit plans: Neighborhood Health Partnership, UnitedHealthcare of the River Valley, UnitedHealthcare.
Frequently Asked Questions including a complete list of included procedure codes can be found here.
As always, ADVOCATE will keep you up to date on this and all issues impacting radiology as they become available.
Lauren Sloan, MHA, RD, LD
Director of Regulatory Affairs