Medicare: New prior authorization process for certain oncology procedures
AI Summary
Effective June 1, 2026, UnitedHealthcare will require prior authorization for outpatient chemotherapy services using the Optum Cancer Guidance Program for members under the UnitedHealthcare Nursing Home Plan and UnitedHealthcare Care Advantage Plan. Any existing regimen approvals granted before this date will need to be resubmitted through the new CGP process.
Action Required
By June 1, 2026: Billing and clinical staff must begin submitting prior authorizations for outpatient chemotherapy services through the Optum Cancer Guidance Program (CGP) via the UnitedHealthcare Provider Portal. Access Prior Authorizations & Notifications, select Oncology, and complete requests on the Optum website. Resubmit any existing regimen approvals granted before June 1, 2026. Failure to obtain prior authorization will result in claim denials for affected cancer patients.
Plan Types
Medicare Advantage
Specialties
oncology, hematology