Washington Prior Authorization Requirements for UnitedHealthcare Exchange Plans
Lists behavioral health services and procedure codes that require prior authorization for UnitedHealthcare Exchange Plan members in Washington; applies to participating behavioral health providers requesting authorizations for inpatient and outpatient services.
No material clinical or coverage changes in this revision.
Coverage Criteria
Emergency and urgent care services do not require prior authorization for UnitedHealthcare Exchange Plan members in Washington. For non-emergent behavioral health services listed in this policy, prior authorization must be obtained before services are provided; failure to obtain prior authorization for covered, non-emergency services may lead to denial of coverage when members lack out-of-network or out-of-service-area benefits.
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