UnitedHealthcare pulled back on plans to implement a controversial gastroenterology endoscopy prior authorization policy that was set to take effect June 1. In its place, the payer set up an advance notification policy for non-screening and nonemergent GI procedures.
Here are seven details about the new policy UnitedHealthcare shared with Becker's:
1. The advance notification requirement for non-screening (surveillance and diagnostic) and nonemergent colonoscopy, esophagogastroduodenoscopies and capsule endoscopy procedures takes effect immediately.
2. The advance notification process will remain in place until UnitedHealthcare's gold-card program launches in early 2024.
3. UnitedHealthcare said advance notification will allow the payer to collect data it needs to accelerate the gold-card program for GI physician groups in early 2024.
4. UnitedHealthcare has not determined whether to pursue additional notification or potential prior authorization for physicians who do not qualify for the gold-card program.
5. Provider groups that do not meet the case load threshold could have rolling admission into the gold-card program as their cases build.
6. Provider groups that do not submit advance notifications during this period will not be considered for the gold-card program.
7. During the advance notification period, UnitedHealthcare said it will not issue medical denials for procedures subject to the program and "instead engage in comprehensive peer-to-peer discussions with board-certified gastroenterologists for procedures that are not aligned with clinical evidence."