MedicaidPrior AuthHigh impact
Rhode Island Medicaid: Prior authorization for outpatient therapies
UnitedHealthcare·RI · Physical Therapy, Occupational Therapy·State news
Effective date
Nov 1, 2025
We identified it
Jan 12, 2026
Summary
Starting November 1, 2025, UnitedHealthcare Rhode Island Medicaid requires prior authorization for all physical therapy, speech therapy, and occupational therapy services (excluding initial evaluations). The first 6 visits within 8 weeks are covered without clinical review but still require prior auth submission.
Action Required
By October 1, 2025: Billing team must update systems to require prior authorization for all PT, ST, and OT services for UnitedHealthcare Community Plan Rhode Island Medicaid members. Submit prior auth requests using the UnitedHealthcare Provider Portal within 2 business days of first service date. Ensure signed referrals, current evaluation reports, care plans, and progress notes are available for submission. Claims will not be paid without prior authorization.