UnitedHealthcare Optum Prior Authorization

UnitedHealthcare Prior Authorization System

In mid-2021, UnitedHealthcare switched from Beacon (Beacon Laboratory Benefit Solutions, Inc.) to their own internal management system: Optum.

What does this mean for you?

New providers that partner with careviso will need to approve careviso as a 3rd party service provider (TIN) within Optum. This will allow us to process UHC prior authorizations and help patients get access to the genetic testing needed for their care.

We look forward to working with your practice!

Frequently Asked Questions

What is Optum and how is it related to UHC?

Optum is part of UnitedHealthcare. They are a business unit under the UHC parent company. The Optum system is used for prior authorizations for genetic testing, medication, and other services.

What is careviso?

careviso is a healthcare technology company that provides prior authorization support and comprehensive services for laboratory genetic testing. careviso helps reduce barriers to access, so that you can focus on your patients’ care.

What agreements does careviso have in place with my practice to do prior authorizations?

careviso follows all compliance guidelines set forth by the OIG to make sure careviso and your practice are HIPAA compliant. We have a Business Associate Agreement (BAA) that was signed with a member of your practice. This BAA establishes careviso’s relationship with your practice which ensures the security of your practice’s data assets. Prior authorization servicing requires access to Protected Health Information (PHI) and having a BAA with careviso helps ensure security and overall HIPAA compliance.

What is the process to grant careviso third-party access to Optum?

careviso is contacting the Optum Administrator associated with the main tax ID that we have for our enrolled clinics. Optum requires that only the Optum Administrator grant third-party TIN access to careviso. To approve careviso access, please sign into Optum and approve the request from CMT* / Jack Kelly. We can provide you with the BAA documentation and details of our enrollment process that we have for your clinic.

What will careviso’s role be within Optum?

careviso has a Billing Services account. This is a standard third-party account (or TIN) that Optum has created to allow third parties to perform prior authorizations. careviso’s account has a system administrator, Jack Kelly, and “users” set up under the main account. The users will be our team of trained PA specialists, who have undergone stringent hiring practices and training on all HIPAA practices and compliance for the systems and data.

The careviso account has restricted access so that the careviso users can only see the prior authorization tile for the clinic, and not the practice claims data.

Why isn’t careviso just a user under my practice account?

Having careviso be a third party (TIN) is a good thing, as this will give careviso the ability to only submit prior authorizations for the account. Optum knows that it is careviso, a third party, doing this on behalf of the practice. This is the correct and compliant way to operate within their prior authorization process.

If careviso was set up as a “user” under the physician office account, Optum wouldn’t know the difference between careviso and the office manager submitting the prior authorizations.