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 – Feb. 28, 2012


UnitedHealthcare Community Plan Medical Policy Update Bulletin



Update to Diagnosis Codes for Body Mass Index (BMI) Documentation Provider Incentive (PDF 66.03 KB)

New Half Tablet Dosage Requirements for Abilify Prescriptions – Effective February 1, 2016 (PDF 59.79 KB)

Use Byram Healthcare for Incontinence Supplies – Effective December 1, 2015 (PDF 422.38 KB)

Updated Drug Policy - 17P/Makena Injection (PDF 62.53 KB)

Attention Durable Medical Equipment Providers Update to Hospital Grade Breast Pumps E0604 Reimbursement - Effective Nov. 1, 2015 (PDF 66.91 KB)

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

Notice of Routine Fee Schedule Change for VFC Program (PDF 47.04 KB)

UnitedHealthcare Responds to Ebola Concerns
(PDF 80.08 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 (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 112.8 KB)
Readmission Policy (F7001) Review FAQ (PDF 248.2 KB) 
Important Change to Durable Medical Equipment Providers Network (PDF 104.59 KB)

CSP NJ Migration Communication
Transition Letter (PDF 101.15 KB) - May 1, 2013
Transition to New Enrollment & Claims System (PDF 101.44 KB) - May 1, 2013
CSP NJ Provider Communication - Dental Correction (DOC 103 KB)  - May 31, 2013
Sample NJ Provider Remittance Advices  (PDF 597.33 KB)

Maternity Policy Change - March 6, 2012 (PDF 40.64 KB)
Secure Fax Alert for Medical Prior Authorization Requests - Oct. 12, 2011 (PDF 20.52 KB)
Synagis Program (PDF 52.46 KB)
Synagis Program 5 Doses (PDF 51.26 KB)

Service Pending Reference Number Process Change Effective Oct. 1, 2011 (PDF 33.99 KB)
UnitedHealthcare Community Plan Transition of Services - FAQ  (PDF 51.98 KB)
New Policies Effective Aug. 14, 2011 (PDF 47.69 KB)
Changes to the New Jersey FamilyCare/Medicaid Program (PDF 47.69 KB)
Vaccines For Children (PDF 25.83 KB)
Prior Authorization Fax Number Changes (PDF 22.35 KB)
2011 Disease Management Information for Providers (PDF 122.23 KB)
Children and Teens Immunization Schedule (PDF 317.05 KB)
National Healthy First Steps Program Update (PDF 18.49 KB)
Notification Status Quick Reference (PDF 59.87 KB)
Cost-Share Grace Period for Dual SNP Members Frequently Asked Questions (PDF 320.18 KB)
Notification Status Step by Step Help (PDF 27.67 KB)
Inpatient/Outpatient Facility Quick Reference (PDF 141.82 KB)
Provider Complaints or Grievances Contact Information (PDF 25.09 KB)
Notification Submission Outpatient Other/Office/DME/HHC Quick Reference (PDF 206.6 KB)
Notification Submission Step by Step Help (PDF 44.47 KB)
Frequently Asked Questions: How to Handle Cost-sharing for UnitedHealthcare Dual Eligible Patients (PDF 61.15 KB) 

Payment Policy Notifications

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)

Ambulance Reimbursement Policy Update for UnitedHealthcare Community Plan of New Jersey-Effective January 1, 2016 (PDF 122.14 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)

Ambulance Reimbursement Policy Update for UnitedHealthcare Community Plan of New Jersey-Effective January 1, 2016 (PDF 122.14 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)

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)
Changes to Existing Reimbursement Policies (DOC 95.5 KB) - Effective May 17, 2014

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

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