South Carolina Prior Authorization Requirements for UnitedHealthcare Exchange Plans
Defines services that require prior authorization for UnitedHealthcare Exchange Plan members in South Carolina and instructs participating behavioral health providers how to submit requests; applies to inpatient and outpatient behavioral health services for these Exchange Plans.
No material clinical or coverage changes in this revision.
Prior Authorization Required Services
Prior authorization required services
Services listed below require prior authorization for Exchange Plan members in South Carolina; member specific benefit documents must be referenced for coverage terms. Prior authorization is not required for emergency or urgent care. To request prior authorization, submit the request online using the Prior Authorization and Notification tool via Sign In on UHCProvider.com. For these benefit plans, members have no non-emergent out-of-network coverage and no coverage outside of the service area.
ALL of the following
Inpatient services
- Inpatient Mental Health — Rev 114, 124, 134, 144, 154, 204
- Inpatient Substance Use Detoxification (hospital based) — Rev 116, 126, 136, 146, 156
- Substance Use Rehabilitation (hospital based) — Rev 118, 128, 138, 148, 158
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