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Bulletins & Payment Policy Notifications

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.

 

Medical Policy Bulletin

UnitedHealthcare Community Plan Medical Policy Update Bulletin

 

Current Bulletins

Revisions to the Early and Periodic Screening, Diagnosis and Treatment (EPSDT) Program Periodicity Schedule (PDF 491.24 KB) - Date Posted 10.18.2017

CHIP Provider Enrollment Information (PDF 444.66 KB) - Date Posted 9.27.2017

2017 Physician Satisfaction Survey Reminder (PDF 92.32 KB) - Date Posted 9.21.2017 

School Vaccination Requirements for Attendance in Pennsylvania Schools (PDF 2.08 MB) - Date Posted 8.4.2017

2017 Recommended Childhood and Adolescent Immunization Schedule (PDF 287.35 KB) - Date Posted 7.06.2017 

Specialty Pharmacy Program Changes Effective June 26, 2017 (PDF 64.11 KB) - Date Posted 6.29.2017

Pennsylvania EPSDT Quick Reference Guide (PDF 155.84 KB) - Date Posted 06.28.2017

Medical Assistance Care Provider Reminder: Valid PROMISe License Required (PDF 45.82 KB) - Date Posted 06.28.2017

Provider Screening of Employees and Contractors for Exclusion from Participation in Federal Health Care Programs and the Effect of Exclusion on Participation - Date Posted 05.05.2017

UnitedHealthcare Community Plan Medicare Claims Processing System Is Being Upgraded – Effective May 20, 2017 (PDF 39.84 KB) - Date Posted 4.9.2017

Nonphysician Health Care Professionals Billing Evaluation and Management Codes Policy – Acupuncturist Update (PDF 216.94 KB) - Date Posted 4.07.2017

Nonphysician Health Care Professionals Billing Evaluation and Management Codes Policy – Acupuncturist Update (PDF 216.66 KB) - Date Posted 3.31.2017

Retirement of Moderate Sedation and Physical Medicine and Rehabilitation: Supervised Modalities Policies, and Changes to Procedure to Modifier and IMRT Policies - Effective May and June 2017 (PDF 202.22 KB) - Date Posted 3.2.2017

Medical Assistance Program Fee Schedule Updates for Long Acting Reversible Contraceptives (LARC) and Certain Family Planning Services (PDF 305.9 KB) - Date Posted 02.17.2017

Environmental Lead Investigations Bulletin

Reportable Diseases Reminder (PDF 159.31 KB)

CDC Recommendations for HPV Shots for Younger Adolescents

Pennsylvania’s Telephonic Psychiatric Consultation Service Programs (TiPS) Quick Reference Guide (PDF 191.21 KB)

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

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

Diabetes Self-Management Education Provider Toolkit (PDF 1.22 MB)

Re-enrollment Requirements for Medical Assistance Providers in Pennsylvania (PDF 60.21 KB)

ABAWD Time Limit Medical Exemption Form (PDF 65.79 KB)

County Assistance Office List for ABAWD Exemption Forms (PDF 377.53 KB)

Able-Bodied Adults Without Dependents (ABAWD) Time Limit Brochure (PDF 1.4 MB)

Pennsylvania Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) Quick Reference Guide (PDF 298.52 KB)

Limited English Proficiency Interpreter Services (PDF 64.04 KB)

Changes to NDC Claim Processing Requirements — Effective March 1, 2016 (PDF 33.98 KB)

 

2015 Bulletins

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

Reminder: Scheduling Appointments around the Philadelphia, PA Papal Visit - Thursday, Sept. 25 through Monday, Sept. 28 (PDF 16.02 KB)

Reminder of State-mandated Re-enrollment Requirements for All Medical Assistance Providers (PDF 62.39 KB)

Valid License Numbers in PROMISe™ (PDF 212.21 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)

UnitedHealthcare Responds to Ebola Concerns (PDF 80.08 KB)

2015 Quarter 3 & 4 Updates: Subsequent Revision Delay for the Radiology Multiple Imaging Reduction and Multiple Procedure Policies (PDF 136.23 KB)

Certain Checks with Paid Date of May 8, 2015, Have Been Reissued (PDF 21.89 KB)

Procedure to Place of Service and Laboratory Services Reimbursement Policy Updates-Effective August 22, 2015 (PDF 191.37 KB)

UnitedHealthcare Community Plan for Adults Quick Reference Guide (PDF 246.04 KB)

EPSDT Quick Reference Guide (PDF 233.69 KB)

Limited English Proficiency Interpreter Services (PDF 196.89 KB)

Special Needs Unit (PDF 108.89 KB)

 

2014 Bulletins

2014 Gold Star Providers Effective December 1, 2014 through June 30, 2015 (PDF 240.48 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)

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

Physical Medicine & Rehabilitation: Multiple Therapy Reduction Policy Reminder (PDF 24.38 KB)

Reminder of State-mandated Re-enrollment Requirements for All Medical Assistance Provide (PDF 62.39 KB)

Reimbursement Policy Changes-Effective Aug. 23, 2014 and New Reimbursement Policies-Effective Sept. 1, 2014 (PDF 195.35 KB)

Changes to Existing Reimbursement Policies ‒ Effective Aug. 1, 2014 (DOC 107.5 KB)

Valid License Numbers in PROMISe™ (PDF 212.21 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)

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)

New Reimbursement Policies and Changes to Existing Reimbursement Policies-Effective Feb. 14, 2015 and Mar. 1, 2015 (PDF 211.02 KB)

Reminder of State-mandated Re-enrollment Requirements for All Medical Assistance Providers (PDF 62.39 KB)

Changes to Existing Reimbursement Policy and Update to New Reimbursement Policy-Effective Nov. 15, 2014

Changes to Existing Reimbursement Policy – Effective May 17, 2014 (PDF 148.09 KB)