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

Communities of Care FAQ (PDF 31.24 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
Transitioning to HIPAA 5010 and ICD-10 - Important Information (PDF 39.5 KB)

UnitedHealthcare Responds to Ebola Concerns (PDF 80.08 KB)

Authorizations & Notifications
Secure Fax Alert for Medical Prior Authorization Requests (PDF 20.52 KB)

Claims & Claim Operations

Enhanced HIPAA Claim Edits Planned for March 2015 (PDF 173.48 KB)
Enhanced HIPAA Edits to be applied to Claim Submissions
Automated Overpayment Adjustment Process (PDF 53.25 KB)
Service Pending Reference Number Process Change Effective Oct. 1, 2011 (PDF 33.99 KB)
Automated Overpayment Adjustment Process (PDF 53.25 KB)

General Health Plan Information

New ID Card and Pharmacy Benefit Provider Transition (PDF 62.23 KB)


Health Services & Programs

Bright Futures™ — Our New Standard for Well-Child Care (PDF 26.63 KB)
Health First Steps OB Referral  (PDF 29.06 KB)
National Healthy First Steps Program Update (PDF 29.06 KB)

Immunization & Vaccination

CDC Hib Vaccine Notice (PDF 23.87 KB)

Pharmacy

Updated Drug Policy - 17P/Makena Injection (PDF 62.53 KB) – Effective October 1, 2012
Synagis Program (PDF 52.46 KB)
Synagis Program 5 Doses (PDF 51.26 KB)

Quality Programs/HEDIS

2015 Quality Improvement Overview (PDF 53.62 KB)

2014 Quality Initiative Overview (PDF 48.98 KB)

QI Overview 2013 (PDF 37.88 KB)


State Specific Information

Direct Acting Antiviral (DAA) Policy (PDF 111.03 KB)

FAQ - Medicaid Primary Care Fee Increase (DOCX 680.2 KB)

RI EOHHS Medicaid Accountable Entity Information

 

Payment Policy Notifications

UnitedHealthcare Community Plan follows CMS and State Medicaid mandates, in the absence of a mandate we follow UnitedHealthcare commercial reimbursement policies. Please refer to the Reimbursement Policy link at the left hand side of this page for a listing of current CMS and/or State Mandated reimbursement policies as well as a link to all additional reimbursement policies.

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)

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

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

Changes to Existing Reimbursement Policies ‒ Effective Aug. 1, 2014 (PDF 233.28 KB)

New Reimbursement Policies ‒ Effective August 4, 2014 (PDF 159.2 KB)

Important New Reimbursement Policy-Vaccines for Children-Effective 5/18/2013
(PDF 43.89 KB)

Readmission Policy - November 2011 (PDF 388.57 KB)