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.

Payment Policy Notifications

Coding Reminder: How to Report Multiple Surgeons for One Operative Session (PDF 737.06 KB) - Date Posted 10.27.2016

Policy Change for the Multiple Procedure Payment Reduction of Diagnostic Imaging Services - Effective Jan. 1, 2017 (PDF 732.87 KB) - Date Posted 10.27.2016

Revision to Maximum Frequency per Day and Bilateral Procedures Policies for Procedure Codes with Bilateral Surgery Indicator of “2” - Effective Feb. 12, 2017  (PDF 110.97 KB)- Date Posted 10.27.2016

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) - Date Posted 8.11.2016

Implementation of the new Clinical Laboratory Improvement Amendments Identification Requirements Policy and the Replacement Codes Policy-Effective August 1 and November 1, 2016. Changes to the Non-Covered Codes, Ambulance, and Nonphysician Health Care Professionals Billing Evaluation and Management Codes Policies-Effective in November and December 2016 (PDF 202.15 KB) - Date Posted - 7.29.2016

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

Phase Two Implementation Delay for Supply Reimbursement Policy (PDF 139.5 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 282.07 KB)

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

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

New Place of Service (POS) 19 and Revision to POS 22-Effective January 1, 2016 and Telemedicine Policy Changes-Effective February 13, 2016 (PDF 177.42 KB)

Reporting Obstetrical Procedure Codes with Date Spans (PDF 140.03 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  (PDF 139.15 KB)

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

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

Changes to Existing Reimbursement Policy and Update to New Reimbursement Policy-Effective Nov. 15, 2014 (PDF 192.84 KB)

Changes to Existing Reimbursement Policies ‒ Effective Aug. 1, 2014 (PDF 233.28 KB)

Reimbursement Policy Changes-Effective Aug. 23, 2014 and New Reimbursement Policies-Effective Sept. 1, 2014 (PDF 195.28 KB)

Provider Preventable Conditions: Health Care Acquired Conditions and Present on Admission Policy Update (PDF 24.65 KB)

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

New Drug Policy and Changes to Existing Reimbursement Policies (PDF 158.86 KB) - Effective February 15, 2014 

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

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

Provider Notification for November Payment Policy Updates/Changes - Nov. 1, 2012 (PDF 205.73 KB)

UnitedHealthcare QUEST Integration Program 
UnitedHealthcare QUEST Expanded Access Program (QExA)
New Policy for Vaccines for Children - Effective 5/18/13  (PDF 43.89 KB)
New and Changed Reimbursement Policies - Effective May 2013 (PDF 60.17 KB) 
Important Information About 17 Alpha-Hydroxyprogesterone Caproate (17P) Injection  (PDF 74.63 KB) 
Automated Overpayment Adjustment Process (PDF 18.68 KB) - December 2011
Secure Fax Alert for Medical Prior Authorization Requests (PDF 20.52 KB) - October 2011
Disease Management Highlight - Diabetes (PDF 50.03 KB) - Summer 2011
Synagis Program (PDF 52.86 KB)
Synagis Program 5 Doses (PDF 51.26 KB)

UnitedHealthcare Community Plan - QUEST Program
Synagis Program (PDF 52.86 KB)
Synagis Program 5 Doses (PDF 51.26 KB)
Frequently Asked Questions: How to Handle Cost-sharing for UnitedHealthcare Dual Eligible Patients (PDF 61.15 KB)