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 – 2.28.2012

Medical Policy Update Bulletin 

UnitedHealthcare Community Plan Medical Policy Update Bulletin


Current Bulletins 

Claims Recoupment Policy Update - Effective Jan. 1, 2017 (PDF 62.78 KB) -  1.11.2017

Benefit Coverage Changes for Long-Acting Opioids (PDF 76.42 KB) - 12.29.2016

24-Hour Maximum for Outpatient Observations Stays (PDF 217.62 KB) - 12.29.2016

2016 Provider Satisfaction Analysis Report (PDF 89.93 KB) - 12.27.2016

2016 Adult CAHPS Analysis Report (PDF 64.15 KB) - 12.27.2016

2016 Child CAHPS Analysis Report (PDF 76.89 KB) - 12.27.2016

Additional Audit Requirements for Facility Claims (PDF 47.39 KB)

Coverage of Gender Dysphoria Related Services (PDF 119.8 KB)

UnitedHealthcare Responds to Ebola Concerns (PDF 80.08 KB)

ER Auto Pay Diagnosis List - Effective October 1, 2015 (PDF 542.07 KB)

Medical necessity reviews for hospital observation claims (PDF 69.68 KB)

At-Home Preventive Screening Option for UnitedHealthcare Community Plan Members (PDF 61.21 KB)

Enhanced HIPAA Claim Edits Planned for March 2015 (PDF 173.48 KB)

STAT Outpatient Laboratory Services Exception List for Referral Process Change - Updated January 2016
(PDF 108.37 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
Occular Screening Medical Policy Cancellation Notice (PDF 23.96 KB)
UnitedHealthcare Sequestration Implementation 
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)
FAQ – Cost Sharing for Dual Eligible Patients (PDF 39.5 KB)
Bright Futures™ — Our New Standard for Well-Child Care?  (PDF 174.08 KB)
2012 Provider Satisfaction Survey Results
(PDF 284.7 KB)2012 CAHPS® Analysis Report – Improving Member Experience and Health Plan Satisfaction (PDF 362.3 KB)
2012 CAHPS® Child Medicaid Survey Analysis Report – Improving Member Experience and Health Plan Satisfaction (PDF 360.79 KB)
Partnership with INSPIRIS CarePlus for Complex/Chronic Medical Conditions - Effective March 1, 2013 (PDF 104.03 KB)
2011 Outreach Program Plan (PDF 2.52 MB)
2010 Consumer Assessment of Health Providers and Systems survey report (PDF 129.06 KB)
Secure Fax Alert for Medical Prior Authorization Requests - Oct. 17, 2011 (PDF 20.52 KB)
Synagis Program (PDF 52.46 KB)
Synagis Program 5 Doses (PDF 44.93 KB)
Service Pending Reference Number Process Change - Oct. 1, 2011 (PDF 33.99 KB)
Prior Authorization Functionality Changing for Maryland (PDF 303.89 KB)
2011 Disease Management Information for Providers (PDF 122.34 KB)
Prior Authorization Fax Number Change (PDF 19.85 KB)
H1N1 Update (PDF 12.35 KB)
Radiology Prior Authorization Program FAQ (PDF 654.18 KB)
HealthChoice Radiology Management (PDF 146.47 KB)
2010 Radiology Prior Authorization List - 1 (PDF 161.03 KB)
2010 Radiology Prior Authorization List - 2 (PDF 135 KB)
Radiology CrossWalk Table (PDF 397.39 KB)
Radiology Clinical Certification Request Form (PDF 2.05 MB)
Radiology Authorization Bulletin for UnitedHealthCare of the Mid-Atlantic (PDF 12.07 KB)
Updates to Member ID cards (PDF 116.9 KB)
Healthy First Steps OB Referral (PDF 105.29 KB)
AmeriChoiceOnline Password Reset Process (PDF 17.94 KB)
Radiology Authorization Bulletin for UnitedHealthcare (PDF 14.1 KB)
Notice Regarding Claims Submitted with Unlisted Codes (PDF 7.19 KB)
New 2010 Primary Adult Care (PAC) Benefits (PDF 15.81 KB)
Important Password Information for Physicians who use AmeriChoiceOnline (PDF 12.93 KB) United Healthcare Supports National Elder Abuse Awareness Day (PDF 33.22 KB)
Updated Drug Policy - 17P/Makena Injection (PDF 62.53 KB) – Effective October 1, 2012


Payment Policy Notifications

New National Drug Code Requirement Policy – Effective May 1, 2017 (PDF 48.38 KB)  
- Date Posted 12.21.2016

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

Claims Recoupment Policy Update – Effective Jan. 1, 2017 (PDF 62.84 KB)

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 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)

Reimbursement Policy Change for Outpatient Radiology Performed in a Maryland HSCRC Rate Regulated Facility - Effective 10/1/2014 (PDF 4.23 MB)

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

Advanced Notification Requirements for Maryland - Effective Oct. 1, 2014
(PDF 255.69 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)

Advanced Notification Requirements for New York - Effective Oct. 1, 2014 (PDF 247.1 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)

Changes to Existing Reimbursement Policy (PDF 144.81 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 62.53 KB)

New Policies Effective Aug. 14, 2011  (PDF 49.97 KB)

Orencia (abatacept) Reimbursement Policy Change  (PDF 31.26 KB)