UnitedHealthcare Community Plan
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See the bulletins below to stay up-to-date on news, policy changes, and other issues important to your practice. Credentialing Update: contact the National Credentialing Center at 1-877-842-3210 – Feb. 28, 2012



Please remember to check our website frequently for updates regarding reimbursement policies, provider manuals and bulletins, providing information to our provider network of changes throughout the year.

Change in Coverage for Dental Benefits for ALTCS Members Who Are 21 Years and Older (PDF 33.44 KB) - 10.12.2016

Payment Responsibility for Behavioral or Physical Health services (PDF 96.67 KB) - Information about submission of services that can help determine if services are considered behavioral health or physical health.


Podiatry Benefit Changes and ALTCS Dental Benefit Changes Notice - 2016 (PDF 40.81 KB)

Cardiology Prior Authorization CPT Code Crosswalk – 2016 (PDF 100.06 KB)

Prior Authorization Cardiology FAQs – 2016 (PDF 88.98 KB)

Prior Authorization Radiology FAQs – 2016 (PDF 66.38 KB)

UHCCP 2016 Radiology Prior Authorization CPT Code Crosswalk (PDF 118.77 KB)

Optum Trauma Informed Care and Services Education Series (PDF 177.57 KB)

New Policy-Evaluation and Management Reimbursement Policy (PDF 123.16 KB)  

Emergency Room Discharge Instructions for Suspect Measles Patients provided by the Arizona Department of Health Services (PDF 224.81 KB)

Inpatient Discharge Instructions for Suspect Measles Patients provided by the Arizona Department of Health Services (PDF 224.1 KB)

English downloadable poster provided by the Arizona Department of Health Services:  Think it might be Measles (PDF 20.85 KB)

Spanish downloadable poster provided by the Arizona Department of Health Services:  Think it might be Measles (PDF 52.32 KB)

DME and Wheelchair Vendor Changes for CRS Members – Effective June 1, 2016 (PDF 47.39 KB)

Changes to the CCI Editing, DME, Incontinence Supply, Lab Services, and T Status Codes Policies - Effective August 20, 2016 and Implementation of the new Consultation Services Policy-Effective September 1, 2016 (PDF 282.09 KB)   

Zika & Pregnancy Information for Providers from ADHS (PDF 94.59 KB)

Home Health Reminder for Dual Special Needs Plan (PDF 153.35 KB)

Reminder: Drug Billing Changes for Injectable Medication (PDF 150.38 KB)

HCBS Client Obligation Provider Notification Process Update (PDF 67.91 KB)

Home Health/Hospice Billing Changes effective (PDF 17.92 KB)

New Prior Authorization Process for Referrals to Out-Of-Network Providers (PDF 46.34 KB) - Notice of change effective 12/1/15 regarding referrals to OON providers and prior authorization changes.

Enhanced Corrected Claim Processing (PDF 253.26 KB) - Information regarding the corrected claims processing improvement.

Denial Trend Bulletin (PDF 28.08 KB) - Information regarding the top denials identified by UnitedHealthcare Community Plan and resources for resolution.

LINK Training and Education

UnitedHealthcare Responds to Ebola Concerns (PDF 80.08 KB)

Foot and Ankle Services Reminder Bulletin (PDF 86.44 KB)

Statewide Plan for Integrated Physical & Behavioral HIE (PDF 234.34 KB) (PDF 234.34 KB) - The Network, Arizona’s statewide HIE operated by Arizona Health-e Connection (AzHeC), has begun the development of a statewide plan to integrate physical and behavioral health information exchange (HIE) under one infrastructure.

Correct Coding and Max Frequency Reminder Bulletin (PDF 40.04 KB) (PDF 40.04 KB)

DME Notice Regarding Preferred Homecare (PDF 25.34 KB) (PDF 25.34 KB) - Notification regarding Preferred Homecare as the Exclusive Provider for DME and Medical Supplies

Obstetrical (OB) Billing Guidelines : Updated OB Billing Guidelines (PDF 99.13 KB)

B-Bundled Codes and Age/Gender Reimbursement Policy Reminder (PDF 23.04 KB)

Change in Coverage for Orthotic Devices for Members Who Are 21 Years and Older (PDF 54.68 KB)

Changes to Blood Lead Screening - Required blood lead screening for children less than six years of age is now based on the child’s risk as determined by either the member’s residential zip code, or presence of other known risk-factors.
Changes to Blood Lead Screening – Facts (PDF 120.62 KB)
Questionnaire – A parent’s to help determine if your child has been exposed to lead (PDF 469.02 KB)
Provider Lead Screening Guide (PDF 1.85 MB)
2014 High Risk Lead Poisoning Zip Codes (PDF 229.54 KB)

AHCCCS Notices Regarding Behavioral Health Benefit Changes for Medicare and AHCCCS Medicaid Members – effective 10/01/15 - AHCCCS provided documents regarding the Behavioral Health changes effective 10/01/15 that affect members enrolled in both AHCCCS Medicaid and Medicare benefits.
Contractor Responsibilities (PDF 372.81 KB)
Frequently Asked Questions for AHCCCS Members (PDF 83.68 KB)
Frequently Asked Questions for Providers (PDF 89.08 KB)

EPSDT Forms and Periodicity Schedules Age 0-21 Years (PDF 204.27 KB) - All members 0-21 years of age should have an Early and Periodic Screening Diagnosis and Treatment (EPSDT) form completed at each Well Child Visit

Billing and Payment Process Change for FQHCs and RHCs (PDF 56.71 KB)

EPSDT Bundling Update  (PDF 61.17 KB)

New interactive web site to help people easily locate a clinic that provides free or low cost primary, family planning, mental and dental health services to people without health insurance. Resources for Low-Cost or No-Cost Clinics in Arizona

How To Submit Corrected Claims Electronically (PDF 41.27 KB) - Information on how to properly submit a corrected claim in ANSI-837 Professional or Institutional format.  

Circumcision Reminder Bulletin (PDF 38.84 KB)

Community Plan Secondary Claims Processing Issue (PDF 47.34 KB) - UHCCP has identified an issue with processing electronically submitted secondary claims.

Minimum Subcontractor  Provisions Update for Long Term Care Network (PDF 19.51 KB)

Added Coverage for Incontinence Briefs for ALTCS Members (PDF 15.11 KB)

Diabetic Supplier Change - Effective 01/01/15 (PDF 63.24 KB)

Updated EPSDT Tracking Forms, Developmental Screenings, and Fluoride Varnish (PDF 43.57 KB) : New EPSDT Tracking Forms are now available for use at well-child/well-care visits for patients 0-21 years of age. Developmental Screening and Fluoride Varnish are enhanced services now available for patients at specified EPSDT visits when PCPs complete the required training and certification. 

UnitedHealthcare Provider Forum Presentation 2014 (PDF 6.35 MB)

Information on how to submit website improvements and other suggestions (PDF 59.09 KB)

Ebola Virus Disease (EVD) Evaluation Algorithm Provided by the Maricopa County Department of Public Health (PDF 199.32 KB)

Ebola Virus Disease (EVD) Web Resources for Healthcare Providers Provided by the Maricopa County Department of Public Health (PDF 198 KB)

AHCCCS Changes and DRG Payment Methodology Notice (PDF 41.86 KB)

Reminder ‐ UB‐04 NPI for Attending or Referring Providers (PDF 50.55 KB)

Participate in the 2014 Arizona Health-e Connection Event Series: Advanced medication management: a success story on reducing hospital readmissions

Wednesday September 3, 2014: A Dinner-Discussion for Providers and Care Managers
Click here to register (PDF 458.59 KB)

Thursday, September 4, 2014: Community Forum
Click here to register (PDF 461.15 KB)

Provider Forum Calendar and WebEx Links (PDF 48.73 KB): Fall 2014 Arizona Provider Forum Calendar


Payment Policy Notifications

Revision to Lupron Policy-Effective January 1, 2017 (PDF 203.22 KB)

New Facility Reimbursement Policy-Appropriate Patient Status for Type of Bill Policy-Effective December 1, 2016  (PDF 180.99 KB) 

New Policy-Evaluation and Management Reimbursement Policy (PDF 123.17 KB)

Phase Two Implementation Delay for Supply Reimbursement Policy (PDF 139.5 KB)

New Intensity - Modulated Radiation Therapy (IMRT) Reimbursement Policy - Effective July 1, 2016 (PDF 122.63 KB)

Facility Billing Policy Update: Reporting an ICD-10 Manifestation Code as a Primary/Principal Diagnosis - Effective July 1, 2016 (PDF 130.9 KB)

Changes to the Obstetrical Services and Supply Policies - Effective May 21, 2016 and Changes to the Inappropriate Primary Diagnosis Codes Policy and Implementation of the New Diabetic Testing Strips and Lancets Policy - Effective June 1, 2016 (PDF 204.94 KB)

REVISED: Adjunct Professional Services Policy - Frequently Asked Questions (PDF 394.63 KB)

Adjunct Professional Services Policy-Frequently Asked Questions (PDF 394.61 KB)

Claims Processing Change for Eight Professional Reimbursement Policies -Effective May 21, 2016 (PDF 145.71 KB)

Revision to Time Span Codes Policy - Effective Fourth Quarter 2015 (PDF 120.08 KB)

Reimbursement and Drug Policy Update for ICD-10 (PDF 183.43 KB)

2015 Quarter 3 & 4 Updates: Subsequent Revision Delay for the Radiology Multiple Imaging Reduction and Multiple Procedure Policies (PDF 136.23 KB)

Procedure to Place of Service and Laboratory Services Reimbursement Policy Updates-Effective August 22, 2015 (PDF 191.37 KB)

Reimbursement Policy Clarification for the Maximum Frequency Per Day Policy and Revision Delay for the Radiology Multiple Imaging Reduction and Multiple Procedure Policies (PDF 139.15 KB)

Changes to Existing Reimbursement Policies - Effective May 2015 (PDF 206.2 KB)

New Reimbursement Policies and Changes to Existing Reimbursement Policies-Effective Feb. 14, 2015 and Mar. 1, 2015 (PDF 211.02 KB)

REVISED: New “X” Modifiers and Impact to UnitedHealthcare Community Plan Reimbursement Policies (PDF 380.73 KB)

New “X” Modifiers and Impact to UnitedHealthcare Community Plan Reimbursement Policies (PDF 376.83 KB)

Physical Medicine & Rehabilitation: Multiple Therapy Reduction Policy Reminder (PDF 24.38 KB)

Changes to Existing Reimbursement Policy and Update to New Reimbursement Policy-Effective Nov. 15, 2014 (PDF 192.62 KB)

New Reimbursement Policies and Changes to Existing Reimbursement Policy for UnitedHealthcare Community Plan Dual Special Needs Plan - Effective Nov. 15, 2014
(PDF 192.25 KB)
Changes to Existing Reimbursement Policies ‒ Effective Nov. 1, 2014
(PDF 233.18 KB)

Reimbursement Policies Changes - Effective Aug. 23, 2014 and New Reimbursement Policies-Effective Sept. 1, 2014
(PDF 195.03 KB)

Changes to Existing Reimbursement Policy (PDF 128.24 KB) – Effective May 17, 2014

Occular Screening Medical Policy Cancellation Notice (PDF 23.96 KB)

New Reimbursement & Drug Policies and Changes to Existing Reimbursement Policies (PDF 161.4 KB) - Effective February 15, 2014

New Medical Policy and Changes to Reimbursement Policies (PDF 174.08 KB)  - Effective November 16, 2013

New and Changed Reimbursement Policies  (PDF 135.2 KB)- Effective Sept. 14, 2013

Provider Preventable Conditions/Healthcare Acquired Conditions Policy  (PDF 31.67 KB)
Information regarding the withholding payments for HCAC's and other PCP's - October 2012

Global Days Policy Reminder  (PDF 41.96 KB)
Reference for policy R0005, effective Aug. 10, 2012


Opening the Doors Special Needs Conference Presentations

Conference White Paper (PDF 355.39 KB)
Exploring Integration for Arizona’s Children’s Rehabilitative Services Program

Setting the Stage, Arizona Landscape (PDF 658.21 KB) by Will Humble, Director for ADHS; Beth Lazare, Deputy Director, AHCCCS; Cory
Nelson, Deputy Director for Behavioral Health, ADHS

Breakout Session A: Integration that Works: A Primary Care Perspective (PDF 472.56 KB) by Kevin Berger, MD, FAAP, FAAHPM, Phoenix
Pediatrics, LTC

Breakout Session B: Integration that Works: The Behavioral Health Perspective (PDF 99.61 KB) byJulia Lesselyong, PsyD, Integrated
Geriatric Behavioral Health Associates (InteGer)

Breakout Session C: Change the Operations of Your Practice to Serve Individuals with Special Needs (PDF 5.52 MB) by Edith Bailey, MD,
Children’s Clinics for Rehabilitative Services in Tucson

Keynote Address (PDF 1.73 MB) by Anita Monoian, CEO of Yakima Neighborhood Health Center
Jocelyn Pedrosa MD, Chief Medical Officer of Yakima Neighborhood Health Center
Rhonda Hauff, Chief Operating Officer/Deputy CEO of Yakima Neighborhood Health Center




Other Announcements

Notice: weekly billing guidelines meeting will be ending Sep. 12th (PDF 83.03 KB)

Overview of Billing Guidelines  (PDF 2.19 MB)

Laboratory Corporation of America (LabCorp) is the new local, exclusively contracted vendor for Laboratory (LAB) . Click here (PDF 39.16 KB) to learn more about this partnership. View the Transition FAQs (PDF 52.13 KB) to help answer questions you may have. Providers are required to use our exclusive contracted vendor Laboratory Corporation of America (LabCorp.) Click here (PDF 90.33 KB) to learn more. - November 1, 2013

Transactions Available April 1st 2014 on UnitedHealthcareOnline.com vs. UHCCommunityPlan.com (PDF 74.65 KB)

Modifier 59 & IP/OP Billing Reminders (PDF 34.01 KB)

Overuse and Misuse of CPT 99285 - Information regarding the billing of CPT 99285 (PDF 50.36 KB)

Optum Cloud Dashboard Claims Management Application (PDF 179.09 KB)

Optum Cloud Dashboard Claims Reconsideration Application (PDF 149.24 KB)

Optum Cloud Dashboard Eligibility and Benefit Application
(PDF 175.86 KB)
AHCCCS Required Reporting for Stillbirths (PDF 57.17 KB)

Developmental Screening at EPSDT (Well-Child) Visits
(PDF 52.53 KB) - Effective April 1, 2014

Member ID’s on Medicare Dual Complete Remits
(PDF 38.7 KB)

Patient Eligibility Medicare Member ID Display Issue
(PDF 34.13 KB)

New Regional Behavioral Health Authority for Maricopa County
(PDF 51.85 KB) - Effective April 1, 2014

CRS Behavioral Health Provider Update
(PDF 39.54 KB)

Physical Therapy Benefit Changes - Effective March 1, 2014 (PDF 59.22 KB)

Oral Health Screening and Fluoride Varnish Application in PCP Office - Effective April 1, 2014
(PDF 68.38 KB) A new preventive treatment in the primary care physician (PCP) office setting is now available for children ages 6 months to 2 years. 

Referring Provider Required, Laboratory Billing Notice
(PDF 94.87 KB) 

System Migration FAQ Effective April 1, 2014
(PDF 73.77 KB)

AZ Pharmacy Network Changes – Announcement
(PDF 37.86 KB) 

AZ Pharmacy Network List
(PDF 333.46 KB)

Health Care Status Codes (Full Descriptions)
(PDF 125.74 KB) 

Claim Adjustment and Reason Code List
(PDF 104.24 KB)

AHCCCS Notice for SMI Members in Maricopa County (English)
(PDF 51.48 KB)
AHCCCS Notice for SMI Members in Maricopa County (Spanish)  (PDF 51.26 KB)

SMI Transition Period Notification
(PDF 121.65 KB) 
Important information regarding the implementation of the new Regional Behavioral Health Authority (RBHA) program for Maricopa County. 

Enhanced HIPAA Edits Applied to Claim Submissions (PDF 527.71 KB)

Changes to Some Co-payments as of January 1, 2014
(PDF 111.05 KB)
As of January 1, 2014, there are changes to co-payments for some AHCCCS members. Refer to the Provider Manual for information about other Co-payments.

CRS Eligibility Verification Overview on AHCCCS Online
(PDF 194.73 KB)  
This document will provide assistance with how to identify a CRS member on AHCCCS Online.

AHCCCS Minimum Insurance Requirements (PDF 23.6 KB)

The updated minimum insurance requirements effective 10/01/13.

CRS Behavioral Health Provider Alert: 90-Day Claim Filing Limit (PDF 189.56 KB)
It is important to file all claims within 90 days, in accordance with your contract. We strongly encourage you to submit your claims through Provider Express or an Electronic Data Interchange (EDI) vendor.

Synagis Program (PDF 52.46 KB) 
PCPs to Update Behavioral Health Providers on Health Status Change (PDF 24.34 KB) – AHCCCS Requirement
Adult Well Visits Reinstated (PDF 46.75 KB) – Effective 10/01/2013
Overpayments and Recoveries Notice (PDF 52.59 KB)
UnitedHealthcare Sequestration Implementation (PDF 93.07 KB)Prohibition of Claims Payment Beyond the Borders of the U.S.  (PDF 41.21 KB)  - Jan. 17, 2012
HEDIS® 2012 Data Collection for UnitedHealthcare and Affiliated Commercial, Medicare and Medicaid Plans Notification - Jan. 26, 2012  (PDF 62.42 KB)
HEDIS 2012 Frequently Asked Questions - Jan. 26, 2012  (PDF 64.85 KB)
Online Password Change  (PDF 19 KB)
Transitioning to HIPAA 5010 and ICD-10 - Important Information  (PDF 39.5 KB)
Bright Futures™ — Our New Standard for Well-Child Care? (PDF 26.63 KB)
Updated Drug Policy - 17P/Makena Injection (PDF 62.53 KB)  – Effective October 1, 2012
Important Change to Durable Medical Equipment Providers Network (PDF 104.59 KB)
PCP's Guide to Enhanced Payments for Primary Care Services  (PDF 38.87 KB)

Note: AHCCCS has indicated per the attached letter (PDF 28.61 KB) , they have advised CMS that Arizona will not be pursuing the Medicare/Medicaid Demonstration program for January 1, 2014.

AHCCCS states: "Arizona will continue to pursue alignment through the use of our managed care model. We will be looking to build off the D-SNP platform moving forward." We expect to maintain our partnership with AHCCCS for our D-SNP plan (UnitedHealthcare Dual Complete) to continue efforts to improve the coordination of care and better meet the needs of AHCCCS members and programs.

In December 2012, we amended the MME benefit plan description into your UnitedHealthcare Community Plan Provider Contract. In light of the new information that the State of AZ is no longer pursuing the MME product, you may disregard this amendment.

Thank you.
UnitedHealthcare Community Plan, Network Management

Provider Remittance Advice Announcement
(PDF 101.49 KB)  - July 10, 2013

Rendering Provider Billing Reminder - May 29, 2013 (PDF 21.07 KB)

Anesthesia Policy Reminder
(PDF 51 KB)

New Simplified Claims Adjustment Process - May 29, 2013
(PDF 37.67 KB)

AzAHP Credentialing/Re-Credentialing Information

Mid-Level Processing Error Notice (PDF 32.76 KB)

New AzEIP Referral Process and Contact List, Effective April 8, 2013 (PDF 222.34 KB)

Notification of New OB Ultrasound Policy - Effective 11/11/12 (PDF 23.9 KB)

Claims Processing System Updates - VFC Requirements 
(PDF 33.14 KB)
New VFC billing changes and the notice of claims processing system updates currently underway.

VFC Changes in Coverage/Reimbursement Policies for Immunizations and Vaccines
(PDF 28.82 KB)

Interpreter Services List
(PDF 23.28 KB)

Quick Reference Guide Radiology Prior Authorization Program
(PDF 175.27 KB)

Frequently Asked Questions Radiology Prior Authorization Program
(PDF 183.19 KB)

Outpatient Radiology Services Providers Reminder
(PDF 58.5 KB)

New Requirements for Submission of Claims for Vaccine Administration

Enhanced Payments to Primary Care Providers

2012 Physician Scorecard
(PDF 99.59 KB) 

HIPAA and ICD-10 Information

OB Ultrasound Policy Notification  (PDF 39.84 KB)  
New OB Ultrasound Policy Notification.

Provider Reenrollment  (PDF 164.16 KB)
As mandated by the Department of Health and Human Services, Centers for Medicaid and Medicare services, and in accordance with the Affordable Care Act, Section 6401, all providers registered with AHCCCS are required to reenroll. To review Frequently Asked Questions click here (post PDF). To go directly to the AHCCCS Provider Registration page, click here:http://www.azahcccs.gov/commercial/ProviderRegistration/packet.aspx

Hospitals Terminating with Vaccines For Children (VFC) Program  (PDF 26.61 KB)
Description: Information regarding the hospitals that have terminated their agreement with the VFC program.

Physician and Provider Demographic Change Submission Form  (PDF 294.5 KB)
Description: Demographic change submission form that can be faxed to UnitedHealthcare Community Plan.

Emergency Transportation Bulletin  (PDF 24.16 KB)
Information regarding diagnosis denials when billing 799.9 - October 2012

New Billing Requirements for Drugs Administered in Outpatient Clinical Settings  (PDF 76.49 KB)

Arizona Health Care Cost Containment System (AHCCCS) is implementing new billing requirements for drugs administered in outpatient clinical settings effective July 1, 2012.

Tamper Resistant Prescription Pads  (PDF 42.02 KB)
Effective Nov. 1, 2012, all handwritten prescriptions for UnitedHealthcare Community Plan enrollees must be written on Tamper Resistant Prescription Pads (TRPP) to be in compliance with federal regulation.

Hospital Claims Edit Letter (PDF 38.49 KB)  - March 2012

AHCCCS News and Updates Portal

March of Dimes-Pertussis Healthcare Providers Hospitals - Feb. 28, 2012 (PDF 629.25 KB)

Taxi Copayment Requirements - Effective April 1, 2012 (PDF 28.1 KB)

Use of Network Outpatient Laboratory Services Providers - Feb. 14, 2012 (PDF 55.37 KB)

Observation vs. Inpatient Reimbursement Guidelines - Feb. 14, 2012 (PDF 66.89 KB)

Cost Sharing Guide for Medicare FFS and Medicare HMO (PDF 34.47 KB)

Missed Appointment Fee For Members Living Outside of Maricopa and Pima Counties (PDF 569.78 KB) - January 1, 2012


Important Information About 17 Alpha-Hydroxyprogesterone Caproate (17P) Injection  (PDF 62.53 KB)- Effective 10/1/2011

Community Plan Online password change (PDF 42.12 KB) - Effective 7/15/2011

Brand Transition Notice (PDF 74.23 KB) - Release 6/03/2011

Cochlear Implants Guidelines (PDF 1.05 MB) - Release 5/24/2011

Guideline for BAHA (PDF 192.94 KB) - Release 5/24/2011

AHCCCS April 1, 2011 Provider Rate Reductions  (PDF 61.3 KB)- Release 4/1/2011

Coordination of Benefits (PDF 56.48 KB) - Release 1/28/2011

DBS for Dystonia (PDF 1.13 MB) - Revised 5/12/2010

United Healthcare Supports National Elder Abuse Awareness Day (PDF 33.22 KB)