News

Welcome to the Harkenhealth Newsroom. Here you will find updated information about our website, press releases, and featured stories.

New Prior Authorization Requirement For Certain Surgical Procedures

Posted Tuesday, April 25, 2017

Consistent with UnitedHealthcare, Harken Health is adding a prior authorization requirement for coverage of certain surgical procedures in an outpatient hospital setting – effective for Harken Health for dates of service on or after 5.1.17

Prior authorizations can be submitted:

  • Online: provider.harkenhealth.com
  • Phone: 800.797.9921
  • Fax: 844.730.3960

If a prior authorization request for one of the procedures is submitted and the site-of-service is an ASC, the prior authorization would be administratively approved. If a prior authorization request for one of the procedures is submitted and the site-of-service is an outpatient hospital setting, a clinical review is required.

Procedures in scope for this policy:

  • Abdominal paracentesis
  • Cardiovascular
  • Carpal tunnel surgery
  • Cataract surgery and other ophthalmologic procedures
  • Cosmetic and reconstructive
  • Gynecologic procedures
  • Hernia repair
  • Liver biopsy
  • Tonsillectomy, adenectomy & other ENT procedures
  • Upper and lower gastrointestinal endoscopy
  • Urologic procedures


Site-of-Service Specialty Medication Prior Authorization Requirements

Posted Tuesday, April 4, 2017

Starting July 1, 2017, Harken Health will adopt UnitedHealthcares site-of-service prior authorization requirements for select specialty medications that require provider administration including but not limited to:

  • Abatacept (Orencia®)
  • Actemra ®
  • Eculizumab (Soliris®)
  • Entyvio ®
  • Eteplirsen (Exondys 51™)
  • Gamunex®-C (IC,SC)
  • Golimumab (Simponi® Aria™)
  • Hizentra ® (SC)
  • HyQvia ® (SC)
  • Infliximab (Remicade® lyophilized concentrate for intravenous use)
  • Infliximab-dyyb (Inflectra™)
  • Octagam ® (IV)
  • Privigen® (IV)
  • Remicade ®
  • Tocilizumab (Actemra® injection for intravenous use)
  • Vedolizumab (Entyvio®)
  • Bivigam™ (IV)
  • Carimune® NF (IV)
  • Cuvitru™ (SC)
  • Flebogamma® DIF (IV)
  • Gammagard® Liquid (IV, SC)
  • Gammagard® S/D (IV)
  • Gammaked™ (IV, SC)
  • Gammaplex® (IV)
  • Octagam® (IV)
  • Privigen® (IV)
  • Gamunex®-C (IV, SC)
  • Hizentra® (SC)
  • HyQvia® (SC)

Administering specialty medications in a hospital setting may mean higher out-of-pocket costs for Harken members, and we aim to ease their financial burden when medically appropriate. Failure to complete the prior authorization process prior to administering  any specialty medication that is subject to a prior authorization requirement will result in claims denial. Providers cannot bill members for services that are denied due to lack of compliance with prior authorization requirements. To see the current list of specialty medications subject to this prior authorization requirement, visit the Advance and Admission Notification Requirements on UnitedHealthcareOnline.com.

If you have questions, please call Harken Health at 800-797-9921.


Prior Authorization Requests- Now Available Online

Posted Thursday, May 26, 2016

You can now submit prior authorizations and check their status online for many services, including inpatient admission notifications.   To complete a prior authorization submission or check status you will need to be logged into the portal.  The online tool is accessed on the Prior Authorizations Tab.

Please note that not all services requiring prior authorization can be submitted online.  Please use the required notifications list located on the Prior Authorizations tab to verify what services require prior authorization. For those services without online functionality please continue to submit prior authorizations via the fax form.   


Harken Health Network Providers

Posted Monday, May 2, 2016

Harken Health is an independently operated affiliate of UnitedHealthcare, Choice Plus contracted providers are automatically a Harken Health provider and the Choice Plus Network fee schedule will be honored by us for the 2016 plan year.  The benefit plans are tiered based on service area and premium designation status.   You may identify your tier using our provider search at harkenhealth. com/search. Preferred Network is our tier 1 with the lowest member deductible, followed by our General Network.  Member specific deductibles can be viewed after log-in.

For mental health benefits, participating providers with Optum Behavioral Health commercial are also participating providers in the Harken network.