Topic

UnitedHealthcare (UnitedHealth Group)

A collection of 1139 issues

How to Get Hemgenix Covered by UnitedHealthcare in Ohio: ICD-10, HCPCS Codes, and Appeal Guide

Answer Box: Getting Hemgenix Covered by UnitedHealthcare in Ohio Hemgenix (etranacogene dezaparvovec) requires prior authorization from UnitedHealthcare OptumRx for Ohio residents. Use ICD-10 code D67 (hereditary factor IX deficiency) and HCPCS code J1411 for billing. Submit PA requests through the UnitedHealthcare Provider Portal or call 888-397-8129. If denied, you have

How to Get Pemazyre (pemigatinib) Covered by UnitedHealthcare in Texas: Appeals Guide & Templates

Answer Box: Getting Pemazyre Covered by UnitedHealthcare in Texas UnitedHealthcare requires prior authorization for Pemazyre (pemigatinib) with step therapy requirements. First step: Submit PA through the UnitedHealthcare Provider Portal with FGFR2/FGFR1 testing results, prior therapy documentation, and ophthalmologic monitoring plan. If denied, you have 180 days to file an

Myths vs. Facts: Getting Fabrazyme (agalsidase beta) Covered by UnitedHealthcare in New Jersey

Answer Box: Getting Fabrazyme Covered by UnitedHealthcare in New Jersey UnitedHealthcare requires prior authorization for Fabrazyme (agalsidase beta) with genetic or biochemical confirmation of Fabry disease and specialist prescriber documentation. If denied, you have 180 days for internal appeals and can access New Jersey's Independent Health Care Appeals

How to Get Venclexta (venetoclax) Covered by UnitedHealthcare in North Carolina: Complete Guide to Forms, Appeals, and Approval

Answer Box: Getting Venclexta Covered by UnitedHealthcare in North Carolina Venclexta (venetoclax) requires prior authorization from UnitedHealthcare in North Carolina for all indications including CLL, SLL, and AML. First step: Download the current OptumRx Prior Authorization Request Form and submit via the UHC provider portal with complete clinical documentation. Step

How to Get Revcovi (Elapegademase) Covered by UnitedHealthcare in Pennsylvania: Appeals Guide & Approval Strategies

Answer Box: Getting Revcovi Covered by UnitedHealthcare in Pennsylvania UnitedHealthcare requires prior authorization for Revcovi (elapegademase) in Pennsylvania. The fastest path to approval: 1) Have your specialist submit a complete PA request through the UnitedHealthcare provider portal with ADA-SCID diagnosis confirmation, prior therapy documentation, and medical necessity justification. 2) If

How to Get Tracleer (bosentan) Covered by UnitedHealthcare in Illinois: Complete Guide to Prior Authorization, Appeals, and State Rights

Quick Answer: Getting Tracleer Covered by UnitedHealthcare in Illinois Tracleer (bosentan) requires prior authorization from UnitedHealthcare, REMS program enrollment, and specialist involvement. Start by having your cardiologist, pulmonologist, or rheumatologist submit a prior authorization request through the UnitedHealthcare Provider Portal with documentation of PAH diagnosis, failed alternatives if step therapy

How to Renew Busulfex (Busulfan Injection) Approval with UnitedHealthcare in New York: Timeline, Documentation & Appeal Rights

Answer Box: Renewing Busulfex Coverage with UnitedHealthcare in New York UnitedHealthcare requires reauthorization for Busulfex (busulfan injection) every 6-12 months with comprehensive clinical documentation. Start renewal requests 4 weeks before expiration to avoid treatment gaps. Required documents include recent office notes, lab results showing therapeutic response, and confirmation of continued

How Long Does It Take to Get Thiola (Tiopronin) Approved by UnitedHealthcare in North Carolina? Complete Timeline & Appeals Guide

Quick Answer: UnitedHealthcare requires prior authorization for Thiola (tiopronin) in North Carolina, typically taking 3-15 business days for initial review. You'll need cystinuria diagnosis (ICD-10: E72.01), 24-hour urine cystine levels >250-300 mg/day, and documented failure of conservative therapy (alkalinization, high fluid intake). If denied, you

How to Get Onpattro (patisiran) Covered by UnitedHealthcare in Washington: Complete Appeals Guide with Templates

Quick Answer: Getting Onpattro Covered by UnitedHealthcare in Washington Fastest path to approval: 1) Ensure genetic testing confirms pathogenic TTR variant, 2) Submit prior authorization through UnitedHealthcare Provider Portal with neurologist evaluation, baseline mNIS+7 and 6MWT scores, 3) If denied, request peer-to-peer review within 24 hours, then file internal

How to Get Onpattro (Patisiran) Covered by UnitedHealthcare in Texas: Complete Coding and Appeals Guide

Answer Box: Getting Onpattro Covered by UnitedHealthcare in Texas UnitedHealthcare requires prior authorization for Onpattro (patisiran) with strict medical necessity criteria including genetic confirmation of hATTR-PN, neurologist evaluation, and specific disease staging. Use ICD-10 code E85.1, HCPCS J0222, and ensure complete documentation before submission. If denied, Texas law guarantees