UnitedHealthcare hasposted new guidance to its website clarifying its advanced notification process, which it originally announced June 1 in place of a planned prior authorization program.
The night before the planned implementation of UHC's controversial prior authorization changes, it instead announced an alternative advanced notification process, which would give compliant practices the opportunity to become "gold card" members in 2024.
The policy shift was immediately met with criticism, as top GI industry leaders believed the announcement lacked clarity.
"AGA has received extremely limited details about this newly proposed program — aside from a proposed framework that would mandate physicians to provide even more data on top of the current burdensome paperwork requirements. This program is a temporary patch — patients will not be denied care tomorrow, but the downstream effects of the program could be as bad or worse for patient access," the American Gastroenterological Association said in a statement to Becker's.
"While UHC has stated they will not 'issue medical necessity denials for procedures that are not aligned with clinical evidence' during 2023 while they 'collect the data received through advance notification to accelerate gold carding for eligible physician groups in early 2024,' what exactly does this mean? Why does UHC need this data? What will they be doing with this data? What data will they require from physician groups?" gastroenterologist Linda Lee, MD, told Becker's.
In an attempt to further clarify the policy, UHC has outlined the procedures that will require advance notification, including esophagogastroduodenoscopies, capsule endoscopies, diagnostic colonoscopies and surveillance colonoscopies. Screening colonoscopies will not be subject to the process.
"The advance notification process for non-screening GI procedures supports our efforts to ensure access to safe and affordable care," UHC wrote on its website.
Throughout 2023, data received through advance notification will be used to select gold card-eligible physician groups for 2024. Providers who do not submit advance notification data will not be eligible.
During the advance notification period, medical necessity denials for procedures not aligned with clinical evidence will not be issued.
There will be no administrative denials for failure to submit advance notification.
"This approach also enables us to identify geographies where underutilization of GI procedures presents an opportunity for us to educate our members about the importance of screening colonoscopies and advanced diagnostic GI procedures," UHC wrote.