AA Providers may request a pre-certification number on an urgent basis if the provider determines that the cardiac procedure is medically required. A pre-certification number will be issued for urgent requests within three hours after UnitedHealthcare receives all required information. If the provider determines that the cardiology service is urgent and must be provided before a preauthorization number can be issued, the cardiac services should be performed and authorization requested retrospectively.
Submit urgent requests by calling 866-889-8054, and select the appropriate option for Neighborhood Health Partnership members. You must state the case is “clinically urgent” and explain the clinical urgency to the clinical decision support representative.
15 What if there is an urgent request scheduled after hours or on a weekend?
AA Please remember that pre-certification is not required for cardiac procedures provided in emergency rooms or urgent care centers. If a cardiac procedure is required on an urgent basis or pre-certification cannot be requested because it is outside of our normal business hours, the service may be performed and uthorization must be obtained retrospectively. Retrospective authorization requests for Electrophysiology Implants & Diagnostic Catheterizations must be made within 15 calendar days after the date of service. Retrospective authorization requests for Echocardiogram & Stress Echo must be made within two business days after the date of service.
AA Under the CPT Code Crosswalk Table, for certain specified CPT code combinations, providers will not be required to modify the existing authorization record. A complete listing of codes is available at myNHP.com > Providers and scroll down to eviCore Pre-Certifications.
However, for code combinations not listed on the CPT Code Crosswalk Table, the provider must modify the precertification record
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