Site of service reviews begin April 1 for ASO customers

UnitedHealthcare will begin site of service (SOS) reviews for self-funded (ASO) UNET customers with Core Medical Necessity. SOS reviews will apply to 1,300 surgical services beginning April 1. SOS builds on Core Medical Necessity prior authorization at no additional cost.

Summary of changes for ASO UNET customers:

  • Commencing on April 1, all new self-funded business will have SOS turned on.
  • Existing self-funded customers with Core Medical Necessity will have SOS review added beginning April 1.
  • For the limited self-funded customers that have SOS reviews currently, the list of services that are subject to SOS review will be expanded to include 1,300 surgical codes.
  • There are no additional fees for SOS review after April 1. 

Site of service joins 5 other Medical Necessity prior authorization programs that were available at no additional fees as of Jan. 1, 2020. Additional Medical Necessity prior authorization services are available today as a buy-up. These include radiology/cardiology, foot surgery, arthroscopy, cancer guidance program and infertility.

Certain UnitedHealthcare fully insured customer plans are already subject to SOS reviews.

As the landscape of health care continues to change, UnitedHealthcare is continuously working to make the health care system more efficient by helping reduce costs for its employers and their employees. With an emphasis on quality, the company’s goal is to provide members with the right care at the right time, in the right place.