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Bulletins and Payment Policy Notifications

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.
 

Medical Policy Update Bulletin 

UnitedHealthcare Community Plan Medical Policy Update Bulletin

 

Current Bulletins

Updated Pharmacy Medication Fill Requirement - 10.30.2017

Updated: HCBS Provider Billing Guide (PDF 78.56 KB) - 10.11.2017

Updated: Billing for Code 99211 - 10.09.2017

Physician Assistants (PA’s) and Advanced Practice Registered Nurses (APRN’s) in Multispecialty Clinics - 10.09.2017

Medicare Severity Diagnosis-Related Groups (MS-DRGs) Grouper Version 35 - 10.3.2017

Prior Authorization Required for Medications - 10.02.2017

HCPCS October 2017 Updates - 10.02.2017

Federal Fiscal Year (FFY) 2018 Payment Rates - 10.02.2017

Other Insurance Verification - 9.25.2017 

Annual Attestation Requirement - 9.25.2017

Work Opportunities Reward Kansans (WORK) Program Manual Update - 9.21.2017

National Correct Coding Initiative (NCCI) and Medically Unlikely Edits (MUEs) Quarterly Updates - 9.18.2017

Prior Authorization for Mental Health Drugs - 9.18.2017

Implementation of Fingerprint-Based Criminal Background Checks Update - 9.8.2017

Kansas Department for Aging and Disability Services (KDADS) Adverse Incident Reporting (AIR) System - 9.5.2017

All MCO Training - 9.5.2017

Prior Authorization Required for Medications - 9.5.2017

Reminder: Claim Recoupment - 8.29.2017 

Mid-Level Providers in a Community Mental Health Center (CMHC) - 8.17.2017

Updated: Crisis Intervention Services - 8.16.2017 

Code A9606 No Longer Considered Content of Service - 8.9.2017

Medicare Crossover Claim Processing Changes - 8.9.2017 

Place-of-Service (POS) Code for Professional Services in a Free-Standing Psychiatric Facility - 8.8.2017

Prior Authorizations Required for Medications - 8.8.2017

Updated: HCBS Reimbursement - 7.24.2017

Updated: Out of State Outlier CCR - 7.18.2017

Mental Health Medication Emergency Supply - 7.19.2017

KanCare All Managed Care Organziation (MCO) Home and Community Based Services (HCBS) Training - 7.11.2017

Provider Application Fee Update - 7.11.2017

Updated: Billing for Code 99211 - 7.11.2017

Budget Reduction Restoration - 7.6.2017 

Home and Community Based Services (HCBS) Intellectual/Developmentally Disabled (I/DD) Supportive Home Care - 7.6.2017

Home and Community Based Services (HCBS) July 2017 Updates - 7.6.2017 

Updated: Psychiatric Residential Treatment Facility (PRTF) Admission Assessment - 7.6.2017 

Updated: Wheelchair Seating Assessments - 7.6.2017 

National Drug Code (NDC) Search Results Issue - 6.28.2017

Psychiatric Residential Treatment Facility (PRTF) Admission Assessment - 6.28.2017

Wheelchair Seating Assessments - 6.28.2017

Inpatient Hospital Utilization Review - 6.26.2017

Psychiatric Observation - 6.22.2017

Home and Community Based Services (HCBS) Intellectual/Developmentally Disabled (I/DD) Reassessments - 6.22.2017

Crisis Intervention Services - 6.22.2017

Additional State Plan Services - 6.19.2017

KanCare Maintenance Medications - 6.19.2017

National Correct Coding Initiative (NCCI) and Medically Unlikely Edits (MUEs) for Code Deactivated - 6.15.2017

Kansas Medicaid Adoption of the Medicare List of Unacceptable Principal Diagnosis Codes - 6.15.2017

Revision of the MS-2126 - 6.12.2017

National Correct Coding Initiative (NCCI) and Medically Unlikely Edits (MUEs) Quarterly Updates - 6.6.2017

MCO Critical Access Hospital Adjustment Factor - 6.6.2017

Discontinued Revenue Code - 6.6.2017

HCBS Provider Billing Guide (PDF 77.49 KB) - 6.5.2017

Provider Input Period for KanCare Renewal - 6.5.2017

Public Notice and Comment Period for KanCare Extension - 6.2.2017

MCO Provider Appeal Process - 6.2.2017

2017

New Clinical Information System (PDF 65.1 KB) - 5.26.2017

Rate Adjustments - 5.26.2017

Medication Prior Authorization - 5.26.2017

Home Health Services - 5.26.2017

Billing for Code 99211 - 5.23.2017 

Institutional Hospital Credit Balance Audits Continue - 5.23.2017

MCO Reconsideration Process - 05.03.2017

Updated Kansas Organizational Provider Credentialing/Recredentialing Application - 4.26.2017

Consolidated Publication Process - 4.26.2017

Claim Reconsideration, Appeal and State Fair Hearing Process (PDF 105.78 KB) - 5.3.2017

Autism Services Updates - 3.31.2017

MCO Quick Reference Guide (PDF 222.72 KB) - 3.30.2017

Covered Procedure Code - 3.28.2017 

CMHC Only Code Part A - 3.27.2017

CMHC Only Code Part B - 3.27.2017

PRTF Reserve Days - 3.27.2017

KanCare All MCO Training Sessions - 3.15.2017 

Extraordinary Funding (PDF 346.51 KB) - 3.10.2017

Reporting Requirements Reminder for Home Telehealth, Nurse Evaluation Visit and Wellness Monitoring (PDF 318.59 KB) - 3.9.2017 

Psychiatric Residential Treatment Facility Billing Instruction - 3.3.2017

Intrauterine Device Rate Increase - 3.3.2017

MS-DRG Grouper Version 34 Implementation and Processing - 2.23.2017

Adverse Incident Management (PDF 157.75 KB) - 2/22/2017 

Medicare Crossover Claim Processing Changes  1/30/2017

Radiation Therapy Codes 2/1/2017

UB-04 Dates 1/17/17

Catheter Aspiration Coverage 1/10/2017

Coverage of 99211 by Registered Nurse (PDF 40.78 KB)  1/6/2017

Updated Coverage Information - FluMist 1/6/2017

Modifier JW Requirements 1/6/2017

Medicare Part D Copayment 1/6/2017

Rates Subject to Budget Reduction  1/3/2017

2017 HCPCS Updates  1/3/2017 
 

2016

Services Considered Content of Service (PDF 45.15 KB)  12/28/2016

HCBS Updates – Enhanced Care Services  12/28/2016

HCBS I/DD Crisis and Exception Process Updates  12/23/2016

2017 Anesthesia Conversion Factor  12/19/2016

MS-DRG Updates  12/19/2016

NCCI MUE Quarterly Updates  12/19/2016

October 2016 ICD-10 Implementation  12/19/2016 

CMHC Billing for Repeat Services 12/13/2016

October 2016 HCPCS Updates  12/13/2016

Surgical Procedures and Sterilization Form Requirements  12/1/2016

IDD Residential Billing Changes (PDF 108.74 KB)  11/29/2016 

Additional Covered Codes  10/25/2016 

Budget Payment Reduction for Out-of-State Providers  10/26/2016

MS-DRG Grouper Version 34  10/7/2016

New HCBS TBI Forms  10/7/2016

Medicare List of Unacceptable Principal Diagnosis Codes  10/7/2016

Codes to Use for New VFC - Covered Flu Vaccine  9/20/2016

Procedure Code Q5101 and Modifier ZA  8/8/2016

July 2016 HCPCS Updates  8/8/2016

Kansas Budget Reductions - Bulletin 16111, 1612816125   7/27/2016 

Anesthesia Procedures  7/18/2016 

Unacceptable Primary Diagnosis Codes  7/18/2016 

KanCare HCBS All MCO Training  7/13/2016

Content of Service Codes  7/13/2016

NEW Live Webcast Friday, July 15: Health Care for Adults with Intellectual and Developmental Disabilities (PDF 219.8 KB)

Third-Party Liability Noncovered Procedure Cost List  6/27/2016

Donor Human Breast Milk (PDF 181.4 KB)  6/27/2016

Removing Authorizations Limits for Behavioral Health (PDF 41.53 KB)

Enhanced Care Services (PDF 41.27 KB)  5/3/2016

April 2016 HCPCS Updates (PDF 41.27 KB)  4/28/206

Provider Training Sessions May 17 in Overland Park and May 24 in Wichita. Click here for details. (PDF 318.37 KB)

KanCare NPI and Modifier Billing Requirements for CMHC's (PDF 237.66 KB)  4/27/2016

KBH-EPSDT Updates  4/27/2016

Overnight Respite Update  4/5/2016

Revised Hospital Rates  4/1/2016

HCPCS 2016 Updates  3/27/2016

HCBS Client Obligation Provider Notification (PDF 67.91 KB)  3/27/2016

Process for Newborn Services Billed Under the Mother’s Beneficiary ID (PDF 45.21 KB)  3/23/2016

Health Homes Program Discontinued (PDF 16.36 KB)  3/17/2016

Prior Authorization Required  3/17/2016

Prior Authorization Required (Ages 0-13)  3/17/2016

OB Sonogram Coverage  3/14/2016

Date of Death  3/4/2016

Hospital Outpatient Clinic Visit Services Update (PDF 60.54 KB)   3/1/2016 

KAN Be Healthy Updates  2/15/2106

Facility Charges (G0463) Non-Coverage Update (PDF 31.38 KB)  2/15/2016

Community Based Services Treatment Team Reimbursement (PDF 52.83 KB)  2/5/2016

New Rates for Sleep Cycle Support Services (PDF 211.72 KB)  2/3/2016

Updated Billing Process for MFP Transitional Services (PDF 48.28 KB)  2/2/2016

2016 MS-DRG Weights and Rates (PDF 46.83 KB)  1/28/2016

2016 Anesthesia Conversion Factor Update  1/26/2016

Personal Care Services Updates  1/15/2016

Hospital Outpatient Clinic Visit Code Coverage  1/7/2016

Home Health Agency and Hospice Skilled Nursing Visits*   1/5/2016
*Important: Though the effective date listed on the KMAP bulletin is Jan. 1, 2016, our effective date will be Feb. 1, 2016.

Hospice Updates *   1/5/2016
*Important: Though the effective date listed on the KMAP bulletin is Jan. 1, 2016, our effective date will be Feb. 1, 2016.

2016 Anesthesia Conversion Factor  1/4/2016

Sleep Cycle Support Rate Change  12/30/2015

HCPCS 2016 Updates  12/7/2015

 

2015

Outpatient Rate Update

Appeals Process

Traumatic Brain Injury and Transitional Living Skills

POS for Physician Service in Outpatient Hospital

HCPCS Updates 2015

DME/Supply Codes

Hedis FAQ for KanCare (PDF 138.73 KB)

NPI Requirements

HPV Vaccine and VFC

VFC Program

Developmental Therapy Services (PDF 85.56 KB)

Mental Health Preadmission Screenings (PDF 20.41 KB)

NPI and Modifier Billing Requirements for CMHCs (PDF 161.7 KB)

Oxygen Probes with Oximeter Rentals (PDF 151.06 KB)

Interim Inpatient Hospital Billing (PDF 36.33 KB)

Home and Community Based Provider ICD 10 Notification (PDF 63.79 KB)

UnitedHealthcare Responds to Ebola Concerns (PDF 80.08 KB)

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

Bone Anchored Hearing Aid Procedure Performed in Two Stages May Only Be Billed Once (PDF 46.59 KB)

Client Obligation Notification Policy Update – Simplified Monthly Reports (PDF 67.99 KB)

Please Submit Federal Sterilization Consent Forms with Claims for Sterilization Procedures for KanCare Members – Effective Immediately (PDF 73.5 KB)

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

May 8th Check Reissue Notice (PDF 21.88 KB)

Billing Guidelines when KanCare Members Have Other Coverage (PDF 51.21 KB)

Coding Updates for Physician Services Provided in an Outpatient Setting (PDF 162.13 KB)

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

HCBS Authorization Unit Limit Increase (PDF 56.86 KB)

Timely Filing Requirements to be Enforced (PDF 28.11 KB)

 

2014

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)

Use of SL Modifier on KanCare VFC Claims (PDF 94.83 KB)

Enhanced HIPAA Claim Edits Planned for March 2015 (PDF 173.48 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! Mail Paper Claims directly to UnitedHealthcare for our KanCare Members – Effective Feb. 1, 2015 (PDF 40.8 KB)
New “X” Modifiers and Impact to UnitedHealthcare Community Plan Reimbursement Policies (PDF 376.83 KB)

Continuity of Care Period for Members with I/DD Waiver Ends – Prior Authorization Now Required for Members to Continue Receiving I/DD waiver services or TCM (PDF 59.38 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)

Reimbursement Policy Changes-Effective Aug. 23, 2014 and New Reimbursement Policies-Effective Sept. 1, 2014 (PDF 195.17 KB)

UB Biller Attending Provider Notice (PDF 164.16 KB)

Active KMAP Number Required PCA12049 (PDF 104.66 KB)

Click here (PDF 196.56 KB) for Atypical Provider Billing Bulletin

Claims for Immunization Administration (PDF 98.3 KB)

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

Provider Preventable Conditions: Health Care Acquired Conditions and Present on Admission Policy Update (PDF 24.65 KB) Enhanced HIPAA Edits to be applied to Claim Submissions

Clinical Practice Guidelines Update: The 2013 Clinical Practice Guidelines were approved by the Community Plan of Kansas Provider Advisory Committee on December 11, 2013. The complete document, including a summary of additions and revisions were posted to the website on January 8, 2014 and can be found here.

Synagis Program 5 Doses (PDF 59.44 KB)
Synagis Program (PDF 55.3 KB)
Occular Screening Medical Policy Cancellation Notice (PDF 23.96 KB)
New Drug Policy and Changes to Existing Reimbursement Policies (PDF 158.36 KB) - Effective February 15, 2014 

 

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)

Reimbursement and Drug Policy Update for ICD-10 (PDF 183.43 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)
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)
Reimbursement Policy Changes-Effective Aug. 23, 2014 and New Reimbursement Policies-Effective Sept. 1, 2014 (PDF 195.17 KB)
Changes to Existing Reimbursement Policy – Effective May 17, 2014 (PDF 148.09 KB)
Provider Preventable Conditions: Health Care Acquired Conditions and Present on Admission Policy Update (PDF 24.65 KB)
Occular Screening Medical Policy Cancellation Notice (PDF 23.96 KB)
New Drug Policy and Changes to Existing Reimbursement Policies (PDF 158.36 KB) - Effective February 15, 2014
New and Changed Reimbursement Policies (PDF 167.74 KB) - Effective November 16, 2013
New and Changed Reimbursement Policies
(PDF 135.2 KB) - Effective Sept. 14, 2013
Readmission Policy Reminder (PDF 119.6 KB) 
Readmission Review FAQ (PDF 248.2 KB) 
New Reimbursement Policy (PDF 55.12 KB) - Effective Feb. 16, 2013
New and Changed Payment Policies (PDF 189.33 KB)  - Effective November 2012
Changes to Online Reimbursement Policies (PDF 19.03 KB) - Effective Aug. 12, 2012
Important New Reimbursement Policy - Vaccines for Children  - Effective 5/18/2013 (PDF 43.89 KB) 
New and Changed Reimbursement Policies  (PDF 60.18 KB)- Effective May 2013  

2013

New Medical Policies and Changes to Reimbursement Policies (PDF 167.74 KB) - Effective November 16, 2013 
Readmission Policy Reminder (PDF 119.6 KB)
Readmission Policy FAQ (PDF 248.2 KB)
New and Changed Reimbursement Policies - Effective May 2013 (PDF 60.18 KB)
Important New Reimbursement Policy - Vaccines for Children (PDF 43.89 KB) - Effective 5/18/2013 
New and Changed Reimbursement Policies (PDF 135.2 KB) - Effective Sept. 14, 2013
United Healthcare Supports National Elder Abuse Awareness Day (PDF 33.22 KB)
FAQ – Cost Sharing for Dual Eligible Patients (PDF 39.5 KB)
Bright Futures™ — Our New Standard for Well-Child Care? (PDF 26.63 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)
Updated Drug Policy - 17P/Makena Injection (PDF 62.53 KB) – Effective October 1, 2012
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)

 

Changes to Reimbursement Policies – Effective Feb. 12, 2012 (PDF 57.55 KB)