UnitedHealthcare Community Plan
You appear to be browsing this site using Internet Explorer 6. This browser is now out of date. For safer, more reliable browsing it is recommended that you upgrade your browser to Firefox, Safari or Internet Explorer 7 or 8.
Shortcut Navigation:
IA_Health_Link-hawki_combined_1

 

NOTICE: Iowa Medicaid care providers must re-enroll with the Iowa Medicaid Enterprise (IME) by July 31 to continue being reimbursed for services by UnitedHealthcare. For additional information about re-enrollment, see Informational Letter 1787.

Please select the state where you practice.

Bulletins & Payment Policy Notifications

See the bulletins below to stay up-to-date on news, policy changes, and other issues important to your practice.

 

UnitedHealthcare Community Plan 

Billing Reminders for FQHCs and RHCs (PDF 76.06 KB) - 7.20.2017

Billing Reminder for Ambulance Services (PDF 48.25 KB) - 7.14.2017

Billing Reminder for Physician Assistants and Advanced Registered Nursing Practitioners (PDF 53.43 KB) - 6.5.2017

Guidelines for Non-Emergent ER Visits (PDF 58.61 KB) - 5.28.2017

Reprocessing Notification for Emergency Room Visit (PDF 39.84 KB) - 5.1.2017

Billing Reminder for HCBS Waiver Transportation (PDF 46.39 KB) - 5.1.2017 

Billing Reminder for Psychiatric Medical Institutions for Children (PMICs) (PDF 46.75 KB) - 4.5.2017

Cotiviti Healthcare to Conduct High-Cost Medication Claims Reviews  (PDF 49.7 KB)- 6.10.2017

Durable Medical Equipment Claim Submission Tips (PDF 50.98 KB) - 3.20.2017

Routine Podiatry Services Claims Submission Tips (PDF 153.75 KB) - 2.01.2017

HCBS & Habilitation Services Claim Submission Tips (PDF 128.73 KB) - 1.11.2017

Immediate Reprocessing Notification for Emergency Room (ER) Visit Claims (PDF 39.85 KB) - 12.23.2016

Client Participation Clarification for HCBS Services and Institutional Settings (PDF 45.58 KB)

Requesting Managed Care Wraparound Payment Supporting Claims Detail Reports (PDF 31.64 KB)

HCBS Rate Floor Reimbursement Increase (PDF 50.78 KB) - 10.14.2016

Changes to Supported Employment & Prevocational Services (PDF 84.23 KB) - 9.16.2016

Billing Reminders for Home Health Services (PDF 49.21 KB) - 9.1.2016 

Many Home Health Services No Longer Require Proir Authorization (PDF 50.94 KB) - 8.18.2016

Billing Reminder for Hospice Services (PDF 68.58 KB) - 8.2.2016

Billing Reminder for CDAC Service Providers (PDF 73.78 KB) - 5.16.2016

UnitedHealthcare Community Plan and OptumRx to Manage Pharmacy Benefits for Iowa Health Link Members (PDF 141.41 KB) - 4.7.2016

Bulletin Archive

Click on the arrow to view bulletins from 2016 and earlier. 

Launch of IA Health Link set for April 1, 2016 (PDF 124.63 KB) - 3.15.2016

UnitedHealthcare Community Plan Added to EPS (PDF 77.64 KB) - 1.28.2016

Billing Reminders for Home Health Services (PDF 49.21 KB) - 9.1.2016 

Many Home Health Services No Longer Require Proir Authorization (PDF 50.94 KB) - 8.18.2016

Billing Reminder for Hospice Services (PDF 68.58 KB) - 8.2.2016

Billing Reminder for CDAC Service Providers (PDF 73.78 KB) - 5.16.2016

UnitedHealthcare Community Plan and OptumRx to Manage Pharmacy Benefits for Iowa Health Link Members (PDF 141.41 KB) - 4.7.2016

Launch of IA Health Link set for April 1, 2016 (PDF 124.63 KB) - 3.15.2016

UnitedHealthcare Community Plan Added to EPS (PDF 77.64 KB) - 1.28.2016

Provider Preventable Conditions: Health Care Acquired Conditions and Present on Admission Policy Update (PDF 24.65 KB)
Enhanced HIPAA Edits Applied to Claim Submissions (PDF 527.71 KB)
Prohibition of Claims Payment Beyond the Borders of the U.S.  (PDF 41.21 KB)  - Jan. 17, 2012
Bright Futures™ — Our New Standard for Well-Child Care?  (PDF 26.63 KB) 
Readmission Policy Reminder (PDF 112.8 KB)
Readmission Policy (F7001) Review FAQ (PDF 248.2 KB)

UnitedHealthcare Sequestration Implementation 
(PDF 93.07 KB)17 Alpha-Hydroxyprogesterone Caproate (17P) Information Effective Oct. 1, 2011 (PDF 74.63 KB)17 Alpha-Hydroxyprogesterone Caproate (17P) Information Effective Oct. 1, 2011 (PDF 74.63 KB)17 Alpha-Hydroxyprogesterone Caproate (17P) Information Effective Oct. 1, 2011 (PDF 74.63 KB)17 Alpha-Hydroxyprogesterone Caproate (17P) Information Effective Oct. 1, 2011 (PDF 74.63 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)HEDIS® 2012 Data Collection for UnitedHealthcare and Affiliated Commercial, Medicare and Medicaid Plans Notification - Jan. 26, 2012
(PDF 62.42 KB)Important Vision Vendor Change - Effective Jan. 1, 2012 (PDF 39.46 KB)
Secure Fax Alert for Medical Prior Authorization Requests - Oct. 12, 2011
(PDF 20.52 KB)H1N1 Update (PDF 12.68 KB)

 

Payer ID Change (PDF 261.02 KB)
Synagis Program (PDF 33.74 KB)
Synagis Program 5 Doses  (PDF 32.92 KB)
2011 Disease Management Information for Providers  (PDF 122.27 KB)
HEDIS 2011 hawk-i  (PDF 80.86 KB)
HEDIS 2011 Lead Screening hawk-i  (PDF 50.39 KB)
2011 Quality Improvement Program Description  (PDF 289.28 KB)
Live And Work Well: How Can You Get Help?  (PDF 19.17 KB)
Updated Drug Policy - 17P/Makena Injection (PDF 62.53 KB) – Effective October 1, 2012

 

 

Payment Policy Notifications

Claim Reprocessing for Rebundling Code 96160 (PDF 48.51 KB) - Date Posted 7.27.2017

Revision to the Intrauterine Device (IUD) Supply Policy (PDF 52.8 KB) - Date Posted 7.12.2017

UnitedHealthcare Community Plan Bilateral Procedures and Maximum Frequency Per Day Policies – Effective Nov. 11, 2017 (PDF 49.38 KB) - Date Posted 6.28.2017

Two Place-of-Service (POS) Codes Added to Facility POS Code List in Two Policies (PDF 54.97 KB) - Date Posted 6.23.2017

New Drug Testing Reimbursement Policy Effective Sept. 1, 2017 (PDF 120.5 KB) - Date Posted 5.31.2017

Nonphysician Health Care Professionals Billing Evaluation and Management Codes Policy – Acupuncturist Update (PDF 216.94 KB) - Date Posted 4.07.2017

UnitedHealthcare Community Plan Medicare Claims Processing System Is Being Upgraded – Effective May 20, 2017 (PDF 39.84 KB) - Date Posted 4.6.2017

Nonphysician Health Care Professionals Billing Evaluation and Management Codes Policy – Acupuncturist Update (PDF 216.66 KB) - Date Posted 3.31.2017

Retirement of Moderate Sedation and Physical Medicine and Rehabilitation: Supervised Modalities Policies, and Changes to Procedure to Modifier and IMRT Policies - Effective May and June 2017 (PDF 202.22 KB) - Date Posted 3.2.2017

New National Drug Code Requirement Policy– Effective May 1, 2017 (PDF 48.37 KB)

Implementation of the new Clinical Laboratory Improvement Amendments Identification Requirements Policy and the Replacement Codes Policy - Effective August 1 and November 1, 2016. (PDF 207.51 KB)

Changes to the Non-Covered Codes, Ambulance, and Nonphysician Health Care Professionals Billing Evaluation and Management Codes Policies - Effective November and December 2016  (PDF 207.51 KB)

Coding Reminder: How to Report Multiple Surgeons For One Operative Session (PDF 732.37 KB)

Revision to Maximum Frequency per Day and Bilateral Procedures Policies for Procedure Codes with Bilateral Surgery Indicator of “2” - Effective February 12, 2017 (PDF 125.61 KB)

Policy Change for the Multiple Procedure Payment Reduction of Diagnostic Imaging Services - Effective January 1, 2017  (PDF 351.3 KB)

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

Payment Policy Notifications Archive

Click on the arrow to view payment policy notifications from 2016 and earilier. 

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 123.16 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)

2015

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)

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

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

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

Changes to Exisiting Reimbursement Policies-Effective Aug. 1, 2014 (PDF 233 KB)

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

Changes to Existing Reimbursement Policy – Effective May 17, 2014 (PDF 148.09 KB)

New Drug Policy and Changes to Existing Reimbursement Policies (PDF 160.18 KB) - Effective February 15, 2014

New and Changed Reimbursement Policies - Effective Sept. 14, 2013  (PDF 133.79 KB)

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)

NCQA Accredited HealthPlan