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UnitedHealthcare Changes Radiology Accreditation and Pre-Authorization
March 10, 2010

This information was recently reported in Imaging Economics:

UnitedHealthcare Changes Radiology Accreditation and Pre-Authorization
Following CMS announcing new accreditation standards, insurance giant, UnitedHealthcare, Minneapolis, is considering revising its own advanced imaging provider accreditation standards. In addition, it is expanding its pre-authorization requirements for imaging. Advanced imaging services are defined by CMS and UnitedHealthcare as CT, MRI, PET, and nuclear medicine. Based on a review of CMS publication that will describe its own criteria, UnitedHealthcare reports that it will review its own accrediting standards and perhaps modify those standards to be aligned with the CMS accreditation requirements.

Should changes be made to its standards, UnitedHealthcare said it will inform providers of the effective date with a formal letter 90-days in advance of implementation.

In addition, effective February 15, 2010, UnitedHealthcare will now require all network physicians (including UnitedHealth Premium® Quality and Cost Efficiency designated physicians) to participate in its Radiology Notification & Authorization Program.

The program requires prior notification for the following outpatient imaging procedures: CT scans, MRIs, MRAs, PET scans, and nuclear medicine studies, including nuclear cardiology. Previously, UnitedHealthcare only required referring physicians who signed up for the pre-authorization program.

The Radiology Notification Program is currently not active in AK, CT, ID, MN, MT, ND, NE, NJ, NY, OR, RI, SD, WA & WY. Additional details about the Radiology Notification Program and its changes are available on this UnitedHealthcare website.

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