UnitedHealthcare will require notification/prior authorization for Crysvita®, a treatment for children and adolescents with X-linked hypophosphatemia recently approved by the U.S. Food and Drug Administration (FDA), for dates of service on or after Oct. 1, 2018.
This requirement applies to all UnitedHealthcare commercial plans including affiliate plans such as UnitedHealthcare of the Mid-Atlantic, UnitedHealthcare Oxford, Neighborhood Health Partnership and UnitedHealthcare of the River Valley.
If care providers administer Crysvita without first completing the notification/prior authorization process, the claim may be denied. Members cannot be billed for services denied due to failure to complete the notification/prior authorization process.
When requested in the outpatient hospital, UnitedHealthcare will evaluate Crysvita based on the site of care for its administration.
For dates of service before Oct. 1, 2018, UnitedHealthcare encourages providers to request pre-service coverage reviews so they can check whether Crysvita is covered before providing services.
Providers can submit authorization requests on UHCprovider.com/priorauth.