Summary
UnitedHealthcare Community Plan of New Jersey revised its FcRn Blockers medical benefit drug policy, expanding coverage for Imaavy (nipocalimab-aahu) in warm autoimmune hemolytic anemia (wAIHA) in adults and pediatric patients 12 and older who are currently or previously treated with corticosteroids. Billing teams should expect new medical-record documentation requirements (confirmed diagnosis, DAT results, prescriber involvement, and prior treatment history), a 12-month initial authorization limit, and the addition of ICD-10 code D59.11 to applicable diagnosis codes.
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What to do
Action · 4 steps
01By 2027-01-01: Billing team should update prior authorization requests for Imaavy in wAIHA for these Community Plan of New Jersey members so each submission includes chart notes, laboratory values (positive or negative DAT with elimination of other hemolysis causes), documented signs and symptoms, corticosteroid or immunosuppressant treatment history, and hematologist involvement.
02Update charge entry and diagnosis coding so wAIHA claims carry ICD-10 D59.11, and add a check that Imaavy is not billed with rituximab or immune globulin for the same indication.
03Tell providers and front desk staff about the 12-month initial authorization limit and the continuation-of-therapy documentation of positive clinical response needed for reauthorization.
04Claims without the required prior authorization or documentation will be denied, per the policy.
Codes mentioned
D59.11
Original notice
FcRn Blockers
uhcprovider.com · Always check the source before changing claims.
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