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.

 

UnitedHealthcare Community Plan Medical Policy Update Bulletin

 

Payment Policy Notificaitons

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)

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)

Higher Reimbursement Rates and Processing Requirements for Naloxone Rescue Kits for UnitedHealthcare Community Plan of New Mexico (PDF 37.02 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)

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

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)

Provider Preventable Conditions: Health Care Acquired Conditions and Present on Admission Policy Update (PDF 24.65 KB)

Changes to Existing Reimbursement Policy (PDF 128.24 KB) – Effective May 17, 2014

Occular Screening Medical Policy Cancellation Notice (PDF 23.96 KB)

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

Readmission Policy FAQ (PDF 248.2 KB)  

Readmission Policy Reminder (PDF 119.6 KB)  

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

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

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

Centennial Care

Changes to Existing Reimbursement Policy and Update to New Reimbursement Policy-Effective Nov. 15, 2014
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)
Provider Preventable Conditions: Health Care Acquired Conditions and Present on Admission Policy Update (PDF 24.65 KB)
Changes to Existing Reimbursement Policy (PDF 128.24 KB) – Effective May 17, 2014
Enhanced HIPAA Edits Applied to Claim Submissions (PDF 527.71 KB)
New Drug Policy and Changes to Existing Reimbursement Policies (PDF 160.18 KB) - Effective February 15, 2014
Prohibition of Claims Payment Beyond the Borders of the U.S. (PDF 41.21 KB)- 1/17/2012
FAQ – Cost Sharing for Dual Eligible Patients (PDF 39.5 KB)
Bright Futures™ — Our New Standard for Well-Child Care? (PDF 26.63 KB) 
New Medical Policy and Changes to Reimbursement Policies (PDF 174.08 KB) - Effective 11/16/2013  
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 - 11/1/2012  (PDF 205.73 KB) 
Updated Drug Policy - 17P/Makena Injection (PDF 62.53 KB) – Effective 10/1/2012
New and Changed Reimbursement Policies (PDF 135.2 KB) – Effective 9/14/2013 
Vaccines For Children (PDF 24.8 KB) 
Readmission Policy FAQ (PDF 248.2 KB) 
Readmission Policy Reminder (PDF 119.6 KB)

CoLTS

Changes to Existing Reimbursement Policy and Update to New Reimbursement Policy-Effective Nov. 15, 2014
Provider Preventable Conditions: Health Care Acquired Conditions and Present on Admission Policy Update (PDF 24.65 KB)
Changes to Existing Reimbursement Policy (PDF 128.24 KB) – Effective May 17, 2014
Enhanced HIPAA Edits Applied to Claim Submissions (PDF 527.71 KB)
Occular Screening Medical Policy Cancellation Notice (PDF 23.96 KB)
New Drug Policy and Changes to Existing Reimbursement Policies (PDF 160.18 KB) - Effective February 15, 2014
Prohibition of Claims Payment Beyond the Borders of the U.S.  (PDF 41.21 KB)- 1/17/2012   HEDIS® 2012 Data Collection for UnitedHealthcare and Affiliated Commercial, Medicare and Medicaid Plans Notification - 1/26/2012  (PDF 62.42 KB) 
HEDIS 2012 Frequently Asked Questions - 1/26/2012  (PDF 64.85 KB)  
Online Password Change  (PDF 19 KB)  
Transitioning to HIPAA 5010 and ICD-10 - Important Information (PDF 39.5 KB)  
Bright Futures™ — Our New Standard for Well-Child Care? (PDF 26.63 KB)   
New Medical Policy and Changes to Reimbursement Policies (PDF 174.08 KB) - Effective 11/16/2013  
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)  
Updated Drug Policy - 17P/Makena Injection (PDF 62.53 KB)  – Effective 10/1/2012 
New and Changed Reimbursement Policies (PDF 135.2 KB) - Effective 9/14/2013 
Vaccines For Children (PDF 24.8 KB)  
Frequently Asked Questions About How to Handle Cost Sharing for Dual-Eligible Patients  (PDF 39.5 KB) 
Cost-Share Grace Period Provider Letter-August 2008  (PDF 29.65 KB) 
Cost-Share Grace Period FAQs-August 2008 (PDF 73.25 KB)   
Automated Overpayment Adjustment Process for 11/21/2011  (PDF 35.8 KB) 
Secure Fax Alert for Medical Prior Authorization Requests - October 2011 (PDF 20.52 KB) 
Synagis Program (PDF 52.46 KB)
Synagis 5 Dose Program  (PDF 44.97 KB) 
Elimination of 28-Day Authorization for Personal Care  (PDF 429.87 KB)  
Elimination of Abstract and FTE Announcement  (PDF 20.33 KB) 
Home and Community Based Providers Re-Contracting Initiative (PDF 352.56 KB) 
Readmission Policy FAQ (PDF 248.2 KB) 
Readmission Policy Reminder (PDF 119.6 KB) 
Pharmacy Notice Regarding Coordinated Long-Term Services (PDF 284.02 KB)