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


Medical Policy Update Bulletin

UnitedHealthcare Community Plan Medical Policy Update Bulletin


Current Bulletins

Registering for and Verifying Your TennCare/Medicaid ID (PDF 38.95 KB) - Date Posted 05.05.2017

Episodes of Care Payment Appeals and Instructions (PDF 125.62 KB) - Date Posted 2.01.2017

Revision to Maximum Frequency per Day and Bilateral Procedures Policies for Procedure Codes with Bilateral Surgery Indicator of "2" - Effective February 12, 2017 (PDF 125.62 KB) - Date Posted 1.17.2017

Revision to Lupron Policy - Effective January 1, 2017 (PDF 203.23 KB)

Bulletin Archive

Click on the arrow above to view the archive. 

UnitedHealthcare Responds to Ebola Concerns (PDF 80.08 KB)

Provider Preventable Conditions: Health Care Acquired Conditions and Present on Admission Policy Update (PDF 24.54 KB)

Physician OB Changes (DOCX 118.9 KB)
Facility OB Changes (DOCX 118.9 KB)
Primary Rate Increase Notice - January 2013
PCP Fee Schedule Increase FAQ - January 2013 (PDF 24.48 KB)
FWA Edit Letter - May 25, 2012 (PDF 19.87 KB)
Budget Reduction Communication - Jan. 1, 2012; (PDF 159.21 KB)
Secure Fax Alert for Medical Prior Authorization Requests - Oct. 12, 2011 (PDF 20.52 KB)
Facility Emergency Room Reimbursement Policy (PDF 5.57 MB)
Disclosure of Ownership and Control Interest Statement and Criminal Information Form FAQ (PDF 56.55 KB)
Service Pending Reference Number Process Change - Oct. 1, 2011 (PDF 34.11 KB)
New Policies Effective Aug. 14, 2011 (PDF 50.3 KB)
Guide to Provider Initiated Notices (PIN) (PDF 33.05 KB)
Budget Reduction Letter (PDF 49.38 KB)
Vaccines For Children (PDF 29.83 KB)
Change in Modifier 53 discount - Effective July 10, 2011 (PDF 29.45 KB)
Provider Alert: Orencia (abatacept) Reimbursement Policy Change (PDF 31.26 KB)
HEDIS 2011 Data Collection (PDF 91.11 KB)
CBRA for Assisted Living Facilities and Adult Care Homes (PDF 21.91 KB)
2010 Radiology Prior Authorization List (PDF 105.15 KB)
Electronic Funds Transfer Alert (PDF 165.97 KB)
Healthy First Steps (PDF 35.52 KB)
Radiology Cross Walk Table (PDF 333.15 KB)
Frequently Asked Questions: How to Handle Cost-sharing for UnitedHealthcare Dual Eligible Patients (PDF 61.15 KB)

UnitedHealthcare Sequestration Implementatio
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)
Readmission Policy Reminder (PDF 112.8 KB)
Readmission Review FAQs (PDF 248.2 KB)
Important Change to Durable Medical Equipment Providers Network (PDF 104.59 KB)
Readmission Policy (F7001) FAQ (PDF 248.2 KB) 

DSM-5 and ICD-10

DSM-5 Notification (PDF 28.54 KB) - May 2013
DSM-5 and ICD-10 FAQ (PDF 44.19 KB)


Payment Policy Notifications

New Drug Testing Reimbursement Policy Effective Sep. 1, 2017 (PDF 70 KB) - 6.19.2017

Changes to Existing Reimbursement Policies (PDF 63.77 KB) - June 16, 2017

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

New National Drug Code Requirement Policy – Effective May 1, 2017 (PDF 48.38 KB)  Date Posted 02.24.2017      

Policy Change for the Multiple Procedure Payment Reduction of Diagnostic Imaging Services - Effective January 1, 2017 (PDF 352.93 KB)  Date Posted 12.01.2016 

New Facility Reimbursement Policy-Appropriate Patient Status for Type of Bill Policy - Effective January 1, 2017 (PDF 213.85 KB)  Date Posted 12.01.2016 

Coding Reminder: How to Report Multiple Surgeons For One Operative Session (PDF 366 KB) - 10.31.2016         

Delay in Multiple Procedure Policy Implementation (PDF 432.54 KB) - Date Posted 10.27.2016

Payment Policy Notification Archive

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 207.51 KB) - Date Posted 8.31.2016

New Policy-Evaluation and Management Reimbursement Policy (PDF 123.16 KB) - Date Posted 7.7.2016             

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 282.15 KB) - Date Posted 6.27.2016

Phase Two Implementation Delay for Supply Reimbursement Policy (PDF 139.5 KB)        

New Intensity-Modulated Radiation Therapy (IMRT) Reimbursement Policy - Effective July 1, 2016 (PDF 124.27 KB)          

Facility Billing Policy Update: Reporting an ICD-10 Manifestation Code as a Primary/Principal Diagnosis - Effective July 1, 2016
(PDF 132.37 KB)

Claims Processing Change for Eight Professional Reimbursement Policies - Effective May 21, 2016 (PDF 145.99 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 204.83 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 177.99 KB)

Reporting Obstetrical Procedure Codes with Date Spans (PDF 140.03 KB)

Subsequent Revision Delay for the Radiology Multiple Imaging Reduction Policy (PDF 135.08 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)

Procedure to Place of Service and Laboratory Services Reimbursement Policy Updates - Effective August 22, 2015 (PDF 191.33 KB)

Changes to Exisiting Reimbursement Policies - Effective May 2015 (PDF 206.2 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 138.66 KB)

Changes to Existing Reimbursement Policies ‒ Effective Feb. 1, 2015 (PDF 235.01 KB)

New Reimbursement Policies an Changes to Existing Reimbursement Policies - Effective Feb 14, 2015 and Mar. 1, 2015 (PDF 211.93 KB)

New “X” Modifiers and Impact to UnitedHealthcare Community Plan Reimbursement Policies (PDF 380.73 KB)
Enhanced HIPAA Claim Edits Planned for March 2015 (PDF 154.58 KB)

Changes to Existing Reimbursement Policy and Update to New Reimbursement Policy - Effective Dec. 15, 2014 (PDF 195.96 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)

Reimbursement Policy Changes-Effective Aug. 23, 2014 and New Reimbursement Policies - Effective Sept. 1, 2014 (PDF 195.37 KB)

Changes to Existing Reimbursement Policies (PDF 147.89 KB) – Effective May 17, 2014

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

Reimbursement Update - February 2013  (PDF 69.3 KB)

New and Changed Reimbursement Policies (DOC 106 KB)  - Effective Sept. 14, 2013

New and Changed Reimbursement Policies  (PDF 60.18 KB)- Effective May 2013 

Notification Update (PDF 69.3 KB) - Effective February 2013
New and Changed Reimbursement Policies (PDF 60.1 KB) - Effective December 2012
Changes to Online Reimbursement Policies (PDF 19.03 KB) - Effective Aug. 12, 2012
Changes to Reimbursement Policies (PDF 57.55 KB) – Effective Feb. 12, 2012