Topic

UnitedHealthcare (UnitedHealth Group)

A collection of 1054 issues

Complete Requirements Checklist to Get Mavenclad (Cladribine Tablets) Covered by UnitedHealthcare in New Jersey: Forms, Timelines, and Appeal Process

Answer Box: Getting Mavenclad Covered by UnitedHealthcare in New Jersey UnitedHealthcare requires prior authorization for Mavenclad (cladribine tablets) through OptumRx, with step therapy requiring documented failure of at least one other MS disease-modifying therapy. Submit electronically via the UnitedHealthcare Provider Portal with complete clinical documentation for 24-72 hour processing. If
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How to Get Strensiq (Asfotase Alfa) Covered by UnitedHealthcare in New Jersey: Complete Prior Authorization Guide with Appeals

Quick Answer: UnitedHealthcare covers Strensiq (asfotase alfa) for pediatric-onset hypophosphatasia through OptumRx with prior authorization. Submit PA documentation including diagnosis confirmation, low alkaline phosphatase levels, and specialist prescription. If denied, you have 60 days for internal appeals and 4 months for New Jersey's external review through Maximus Federal
6 min read

How to Get Hemgenix (etranacogene dezaparvovec) Covered by UnitedHealthcare in Pennsylvania: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Hemgenix Covered by UnitedHealthcare in Pennsylvania UnitedHealthcare requires prior authorization for Hemgenix (etranacogene dezaparvovec) with strict eligibility criteria including age 18+, severe/moderately severe hemophilia B, 50+ factor IX exposure days, and treatment at a hemophilia center. If denied, Pennsylvania's Independent External Review Program offers
6 min read

Lowering Out-of-Pocket for Signifor / Signifor LAR (pasireotide) with UnitedHealthcare in New Jersey: Copay, Tiering & Assistance

Quick Answer: Reducing Your Signifor LAR Costs with UnitedHealthcare in New Jersey UnitedHealthcare requires prior authorization for Signifor LAR (pasireotide) with potential high specialty tier costs. Key cost-reduction strategies include the manufacturer's $20 copay program for commercial insurance, foundation grants up to $13,600/year, and formulary tier
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Coding That Helps Get Elelyso (Taliglucerase Alfa) Approved in Washington with UnitedHealthcare: ICD-10, HCPCS J-Code, and Billing Guide

Answer Box: Fast Track to Elelyso Coverage Getting Elelyso (taliglucerase alfa) covered by UnitedHealthcare in Washington requires precise coding and documentation. Use ICD-10 code E75.22 for Gaucher disease, HCPCS J-code J3060 for billing (10 units per code), and calculate total dose ÷ 10 for billable units. Submit prior authorization through
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How to Get Alprolix Covered by UnitedHealthcare in New Jersey: PA Forms, Appeals, and State Resources

Answer Box: Getting Alprolix Covered by UnitedHealthcare in New Jersey UnitedHealthcare requires prior authorization (PA) for Alprolix through OptumRx, with coverage contingent on confirmed hemophilia B diagnosis, hematologist prescription, and documented failure of standard half-life factor IX therapy (≥50 exposure days). Submit PA via the UnitedHealthcare Provider Portal with medical
6 min read

Renewing Galafold (Migalastat) Coverage with UnitedHealthcare in Illinois: Timeline, Documentation, and Appeal Options

Answer Box: Renewing Galafold Coverage with UnitedHealthcare in Illinois UnitedHealthcare requires annual reauthorization for Galafold (migalastat) with documentation of positive clinical response. Submit renewal requests 30-60 days before expiration through OptumRx with specialist notes showing treatment response (reduced GL-3 levels, stable kidney function). If denied, you have 180 days for
6 min read

How to Get Hetlioz (Tasimelteon) Covered by UnitedHealthcare in Illinois: Complete Prior Authorization and Appeals Guide

Quick Answer: Getting Hetlioz Covered by UnitedHealthcare in Illinois UnitedHealthcare requires prior authorization for Hetlioz (tasimelteon) with mandatory step therapy requiring a 30-day melatonin trial failure. You'll need diagnosis documentation (Non-24 sleep disorder ICD-10 G47.24 or Smith-Magenis syndrome), specialist consultation, and submission via OptumRx specialty pharmacy. First
6 min read

How to Get Tepezza (Teprotumumab) Covered by UnitedHealthcare in New Jersey: Complete Prior Authorization and Appeals Guide

Answer Box: Tepezza Coverage with UnitedHealthcare in New Jersey UnitedHealthcare requires prior authorization for Tepezza (teprotumumab) in New Jersey for moderate-to-severe thyroid eye disease. Your ophthalmologist or endocrinologist must submit documentation showing Clinical Activity Score ≥3, euthyroid status, and failed corticosteroid treatment via the UHC Provider Portal. If denied, New
6 min read