In May, UnitedHealthcare announced plans to eliminate prior authorization requirements for chiropractic services by the end of 2026. We have not yet seen evidence of this change. UnitedHealthcare stated that it will update its provider portal before any new policy takes effect.
At the same time, UnitedHealthcare has moved many chiropractors to Tier 2, which will require them to begin obtaining prior authorizations in October. This appears to conflict with the company’s stated plan to eliminate prior authorization requirements. If UnitedHealthcare has moved you to Tier 2, please contact the WCA Help Desk and let us know.
United healthcare has stated to their consumers the top reasons for receiving denied care, and the reasons are as follows:
- Eligibility – there’s a possibility the patient is not actually enrolled in the health plan.
- Duplicates – the provider inadvertently submitted multiple claims for the same treatment or service.
- Documentation – the provider didn’t submit all the information necessary to review the claim, such as the results of lab tests or diagnostic imaging tools like MRI and CT scans.
- Coverage – the plan sponsor (employer, federal government, state government, private health insurance company that offers advantage plans, or affordable care act marketplace plans that you choose) opted to not include coverage for that particular service or procedure when designing their health plan.
- Clinical quality and safety – the care provided does not align with widely accepted, evidence-based clinical guidelines. In some cases, providers recommend services that may not be supported by the current clinical evidence and established standards.
These factors may explain some denials, but they do not capture every cause. Providers can make submission errors, but denials may also result from insurer processes, coverage rules, and policy changes.
If you have any questions regarding this article, please contact Jacqlyn at the WCA Help Desk, 608-292-1804 or wcahelp@wichiro.org.