New Jersey Prior Authorization Requirements for UnitedHealthcare Exchange Plans
Lists behavioral health services and procedure/revenue codes that require prior authorization for UnitedHealthcare Exchange Plans members in New Jersey (inpatient and outpatient behavioral health). Excludes emergency/urgent care and notes members have no non-emergent out-of-network coverage or coverage outside the service area.
No material clinical or coverage changes.
Policy summary
This policy lists behavioral health services and associated procedure/revenue/CPT codes that require prior authorization for participating UnitedHealthcare Exchange Plans members in New Jersey for inpatient and outpatient behavioral health. Emergency and urgent care are exempt. Prior authorization requests must be submitted online via the Prior Authorization and Notification tool accessed through Sign In on UHCProvider.com. Effective date: 2024-01-01. Status: CURRENT. When deciding coverage, reference the member specific benefit plan document because plan terms vary by state.
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