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.

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)

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)
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)
New Reimbursement Policies and Changes to Existing Reimbursement Policy for UnitedHealthcare Community Plan Dual Special Needs Plan-Effective Nov. 15, 2014 (PDF 192.25 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)
New Policy and Billing Requirements for Elective Delivery (C- Section and Induction of Labor) Before 39 Weeks Without Medical Indication (PDF 601.71 KB)
Changes to Existing Reimbursement Policy – Effective May 17, 2014 (PDF 148.09 KB)
Occular Screening Medical Policy Cancellation Notice (PDF 23.96 KB)
New Drug Policy and Changes to Existing Reimbursement Policies (PDF 158.86 KB) - Effective February 15, 2014 
Readmission Policy Reminder (PDF 112.8 KB)
Readmission Policy (F7001) Review FAQ (PDF 248.2 KB)
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 
Updated Drug Policy - 17P/Makena Injection (PDF 62.53 KB)  – Effective September 23, 2015 
Important Change to Durable Medical Equipment Providers Network (PDF 104.59 KB) 
New and Changed Reimbursement Policies (PDF 135.2 KB) - Effective Sept. 14, 2013 
Payment Policy Changes - Effective November 2012
(PDF 205.84 KB) 
Reimbursement Policy Update (PDF 13.16 KB)



Helpful Tips for New Billing Requirements for Vaccines for Children Services (PDF 40.32 KB) 
NY Primary Care Rate Increase Attestation Now Available  (PDF 57.7 KB)
CHPlus Diagnosis and Treatment of an Autism Spectrum Disorder Rider - January 2013  (PDF 120.93 KB)
Update to New York HIV Testing Law Effective September 1, 2010  (PDF 27.72 KB)
Automated Overpayment Adjustment Process - Jan. 17, 2012  (PDF 53.22 KB)
Secure Fax Alert for Medical Prior Authorization Requests - Oct. 17, 2011  (PDF 20.52 KB)
Medical Outpatient Prior Authorization Medical Necessity Update/Reminder  (PDF 20.5 KB)
Synagis Program  (PDF 245.92 KB)
Synagis Program 5 Doses (PDF 51.26 KB)
Service Pending Reference Number Process Change - Oct. 1, 2011  (PDF 33.99 KB)
Vaccines For Children  (PDF 29.83 KB)
Quality Improvement Program  (PDF 25.57 KB)
Provider Alert: Orencia (abatacept) Reimbursement Policy Change  (PDF 31.26 KB)
Prior Authorization Fax Number Changes (PDF 21.31 KB) 
Medical Reconsiderations 
(PDF 26.94 KB)
2009 Fraud, Waste and Abuse Training Materials  (PDF 794.7 KB)
Cost-Share Grace Period for Dual SNP Members FAQ  (PDF 320.18 KB)
Dual-Eligible Special Needs Plans Provider Information  (PDF 34.18 KB)
CDC Recommendations for Early Influenza Antiviral Treatment  (PDF 52.39 KB)
Electronic Health Record Open House  (PDF 163.73 KB)
Radiology Clinical Certification Request Form  (PDF 71.59 KB)
Radiology CrossWalk Table  (PDF 424.28 KB)
Radiology Prior Authorization Program FAQ  (PDF 318.05 KB)
2010 Radiology Prior Authorization List  (PDF 105.35 KB)
Radiology Authorization Bulletin for UnitedHealthCare of the Mid-Atlantic  (PDF 12.07 KB)
HEDIS 2010 Data Collection  (PDF 52.26 KB)
HEDIS 2010 Frequently Asked Questions  (PDF 42.26 KB)
Medicaid Administrative Guide  (PDF 6.21 KB)
Medical Director Meetings  (PDF 22.84 KB)
CDC Advisory Regarding Propofol  (PDF 19.25 KB)
H1N1 Update  (PDF 19.74 KB)
Health First Steps  (PDF 38.43 KB)
Healthy First Steps OB Referral  (PDF 35.55 KB)
Prior authorization functionality change for New York  (PDF 15.02 KB)
New 2010 Primary Adult Care (PAC) Benefits  (PDF 15.81 KB)
National Healthy First Steps Program Update  (PDF 38.43 KB)
UnitedHealth Group Integrity of Claims, Reports and Representations to Government Entities Policy  (PDF 30.56 KB)
Notice Regarding Claims Submitted with Unlisted Codes  (PDF 6.41 KB)
Updates to Member ID cards  (PDF 116.9 KB)
Important Password Information for Physicians who use AmeriChoiceOnline (PDF 12.82 KB)