New Jersey Medicaid: View cite provision for DME prior authorizations

To comply with federal requirements, beginning June 1, 2025, you’ll need to request the exceptional circumstances provision when you submit a prior authorization for durable medical equipment (DME) for UnitedHealthcare Community Plan of New Jersey members.

DME is now under the Home Health DME and Supplies Exceptional Circumstances Provision, which requires you to cite the exceptional circumstances provision request within the prior authorization. If we don’t receive the prior authorization request with the exceptional circumstance provision included, your request for DME will be denied.

How to request services under the provision

• Submit a prior authorization
  • From any page on UHCprovider.com, select Sign In at the top-right corner
  • Enter your One Healthcare ID 
  • New users who don’t have a One Healthcare ID: Visit the Provide Portal registration page to get started
  • From the left-hand tabs, select Prior Authorizations & Notifications. Then, click “Create a new request.” 
  • Select the appropriate prior authorization type from the dropdown 
  • Enter the required information and click Continue
• Under Comments, cite you’re requesting the exceptional circumstances provision and list the justification for the specific home health service(s)
• If the exceptional circumstances provision is cited, you must include a reference and explain the member’s need for the requested home health care service(s).

Federal regulations provide general guidance on allowed equipment that typically wouldn’t be needed by someone without a disability, illness or injury, or supplies that are consumable and disposable items to address an individual’s need.