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.

Archives

 

 

 

Billing Guidelines for EPSDT Modifiers (PDF 42.12 KB)

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

UnitedHealthcare Responds to Ebola Concerns (PDF 80.08 KB)

Update on Physician Fee Schedule for 2014 PPACA PCP Medicaid Fee Increase Rate Change (PDF 60.47 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)
Nebraska Connecting With the Community (PDF 62.15 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) 
FAQ – Cost Sharing for Dual Eligible Patients (PDF 39.5 KB)
Bright Futures™ — Our New Standard for Well-Child Care? (PDF 26.63 KB) 
Readmission Policy Reminder (PDF 119.6 KB) 
Readmission Policy FAQ (PDF 248.2 KB)   (PDF 205.73 KB) 
Important Change to Durable Medical Equipment Providers Network (PDF 104.59 KB) 
New Emergency Room Facility Reimbursement Policy for Nebraska (PDF 96.54 KB)  - Effective Oct. 15, 2013  
Automated Overpayment Adjustment Process- January 23, 2012 (PDF 37.41 KB) 
Synagis Program (PDF 52.85 KB) 
Synagis Program 5 Doses (PDF 51.26 KB)
Service Pending Reference Number Process Change - Oct. 1, 2011 (PDF 64.68 KB) 
2011 Disease Management Information for Providers (PDF 122.34 KB) 
Prior Authorization Fax Number Change (PDF 37.72 KB) 
Frequently Asked Questions: How to Handle Cost-sharing for UnitedHealthcare Dual Eligible Patients (PDF 61.15 KB) 
United Healthcare Supports National Elder Abuse Awareness Day (PDF 33.22 KB)
Updated Drug Policy - 17P/Makena Injection (PDF 62.53 KB) – September 23, 2015

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) 

Archive

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)

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)

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

New Policies Effective Aug. 14, 2011 (PDF 58.65 KB)

 

Nebraska Medicaid Program

Provider Bulletins