UnitedHealthcare is set to remove nearly two-thirds of prior authorization requirements for pediatric services across a number of specialties, including orthopedics, according to a May 29 news release from the company.
Here are five things to know:
- Prior authorization requirements will be dropped for many diagnostic services, routine surgical procedures and pediatric specialty care including orthopedics, cardiology, neurology and pulmonology.
- Authorization waivers will be introduced for certain procedures performed at leading pediatric hospitals, representing pediatric centers across medical and surgical specialties.
- UnitedHealthcare is conducting data-driven reviews of all pediatric prior authorization requirements to determine which services do not need approval.
- Services that have higher clinical complexity or variability, including experimental treatments and specialty drugs will continue to require pre-approval.
- The changes apply to the company’s commercial and Medicare plans and will be in place by the end of the year.
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