UnitedHealthcare Community Plan
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Cancer - Oncology 

UnitedHealthcare Injectable Chemotherapy

Prior Authorization Program

Effective May 17, 2014, UnitedHealthcare will implement a new Injectable Chemotherapy Prior Authorization Program in Florida for members with benefit coverage through:

·   Neighborhood Health Partnership
·   UnitedHealthcare (excluding indemnity/PPO membership)
·   UnitedHealthcare Community Plan (excluding UnitedHealthcare at Home and UnitedHealthcare’s Health & Home Connection membership, formerly known as Evercare).

The Injectable Chemotherapy Prior Authorization Program is designed to expedite the review of treatment compliance with the National Comprehensive Cancer Network’s (NCCN) Guidelines and Compendium as the source for our chemotherapy coverage decisions. We use NCCN for our coverage review because of its reputation as an expert resource for oncologists and because its recommendations are transparent to physicians, patients and payers. Requests will be submitted via a web-based application.

This prior authorization program is designed to prevent claim denials after a member has received injectable chemotherapy treatment and supports the physician in the following ways:

·   Allows physicians to submit clinical information during the authorization process for members with medical contra-indications to an NCCN-recommended regimen.
·   Provides physician-to-physician discussions with an oncologist prior to an adverse determination, which may prevent denials from occurring after the treatment has been given.
·   Authorizations that follow NCCN regimens will be approved at the time the physician submits the online request for prior authorization.
·   Requests for pediatric chemotherapy regimens, rare cancers, or chemotherapy regimens that are not NCCN-recommended, can also receive a response within three business days if necessary supporting documentation is provided at the time of the prior authorization request.

To support this process, we have contracted with CareCore National’s Oncology Division, a UnitedHealthcare contracted vendor for utilization management, and will allow the provider to obtain injectable chemotherapy authorizations on the vendor website: medicaloncologyauthorizations.com.

We request that all prior authorizations be completed online.  If you are experiencing internet connection problems or have a question you may call 855-252-1116 Monday through Friday from 7a.m. to 7p.m. (EST).   

Additonal Resources