Topic

UnitedHealthcare (UnitedHealth Group)

A collection of 1144 issues

Coding That Helps Get Orkambi (Lumacaftor/Ivacaftor) Approved by UnitedHealthcare in Florida: ICD-10, HCPCS, and NDC Requirements

Answer Box: Quick Path to Orkambi Coverage Getting Orkambi (lumacaftor/ivacaftor) covered by UnitedHealthcare in Florida requires specific coding and documentation. Use ICD-10 code E84.0-E84.9 for cystic fibrosis manifestations, submit genetic testing confirming F508del homozygous status, and ensure a CF specialist prescribes the medication. Submit prior authorization through
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Renewing Fabrazyme (Agalsidase Beta) Approval with UnitedHealthcare in Michigan: 2025 Requirements and Timeline

Answer Box: Renewing Fabrazyme with UnitedHealthcare in Michigan Fabrazyme requires annual reauthorization with UnitedHealthcare, typically 12 months after initial approval. Start the renewal process 30 days before expiration to avoid coverage gaps. Submit updated clinical documentation showing treatment response through your provider's UnitedHealthcare portal or OptumRx system. If
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UnitedHealthcare's Coverage Criteria for Gattex (Teduglutide) in Pennsylvania: What Counts as "Medically Necessary"?

Answer Box: Getting Gattex Covered by UnitedHealthcare in Pennsylvania UnitedHealthcare requires prior authorization for Gattex (teduglutide) with strict medical necessity criteria: documented short bowel syndrome, 12+ months of parenteral nutrition dependence (≥3 days/week), failed enteral optimization attempts, and recent colonoscopy with polyp removal. Fastest path to approval: Submit complete
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How to Get Orladeyo (Berotralstat) Covered by UnitedHealthcare in New Jersey: Complete Guide with Forms and Appeal Templates

Answer Box: Getting Orladeyo Covered by UnitedHealthcare in New Jersey Orladeyo (berotralstat) requires prior authorization from UnitedHealthcare in New Jersey. To get approved: 1. Visit an HAE specialist (allergist/immunologist) who can document your hereditary angioedema diagnosis with C1-INH testing and attack frequency 2. Submit prior authorization through the UnitedHealthcare
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Getting Jaypirca (Pirtobrutinib) Approved by UnitedHealthcare in Virginia: Complete Guide to Coverage, Appeals, and Forms

Answer Box: Fast Track to Jaypirca Coverage in Virginia Getting Jaypirca (pirtobrutinib) approved by UnitedHealthcare in Virginia requires prior authorization and documentation of failed BTK inhibitor therapy. The fastest path: 1) Gather records of prior BTK inhibitor treatment (ibrutinib, acalabrutinib, or zanubrutinib) and failure/intolerance, 2) Submit complete prior authorization
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How to Get Venclexta (venetoclax) Covered by UnitedHealthcare in California: Prior Authorization Guide & Appeal Scripts

Quick Answer: Getting Venclexta Covered by UnitedHealthcare in California Venclexta (venetoclax) requires prior authorization from UnitedHealthcare for CLL, AML, and other approved blood cancers. The fastest path: Your oncologist submits PA documentation showing your diagnosis, tumor lysis syndrome monitoring plan, and any required prior therapies. If denied, California's
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UnitedHealthcare's Coverage Criteria for Keytruda in Washington: What Counts as "Medically Necessary"?

Answer Box: Getting Keytruda Covered by UnitedHealthcare in Washington To get Keytruda (pembrolizumab) covered by UnitedHealthcare in Washington, you need prior authorization with specific biomarker testing results (PD-L1 CPS ≥1, MSI-H, or TMB-H ≥10 mutations/megabase for most indications). Submit through the UnitedHealthcare Provider Portal with complete pathology reports, clinical
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How to Get Breyanzi Covered by UnitedHealthcare in California: Complete Prior Authorization Guide

Quick Answer: Getting Breyanzi Approved by UnitedHealthcare in California Breyanzi (lisocabtagene maraleucel) requires prior authorization from UnitedHealthcare before administration. To get approval: (1) Submit a complete PA request through the UnitedHealthcare Provider Portal with diagnosis documentation, prior therapy records, and REMS facility certification; (2) Allow 72 hours for standard review
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Myths vs. Facts: Getting Opsumit (Macitentan) Covered by UnitedHealthcare in Ohio

Answer Box: Getting Opsumit Covered by UnitedHealthcare in Ohio Eligibility: UnitedHealthcare requires prior authorization for Opsumit (macitentan) with documented PAH diagnosis, WHO functional class II-IV, and specialist involvement. Fastest path: Submit comprehensive PA request through UnitedHealthcare Provider Portal with complete clinical documentation. First step today: Gather PAH diagnosis confirmation, functional
5 min read