UnitedHealthcare Community Plan
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For important announcements from the Texas Health and Human Services Commission, please go to the Provider Information tab.

 

See the bulletins below to stay up-to-date on news, policy changes, and other issues important to your practice.

Electronic Visit Verification

Reason Code News - 11.18.2016

Complete List of Reason Codes - 11.18.2016

Medicaid Electronic Visit Verification (EVV) Small Alternative Device Agreement and Order - 7.28.2016

Medicaid EVV Small Alternative Device Agreement (Spanish) - 11.3.2016

HHSC EVV Provider Compliance Plan Notification (PDF 93.25 KB) - posted 6.1.2016

About The HHSC EVV Provider Compliance Plan Notification (PDF 415.27 KB) - posted 6.1.2016

Provider Compliance Plan for UnitedHealthcare Community Plan EVV (PDF 230.77 KB) - posted 5.27.2016

Revised Form: H1002 Provider Electronic Visit Verification Vendor System Selection - posted 1.26.2016

Community First Choice Providers EVV Training (PDF 36.99 KB) - posted 1.26.2016

EVV Compliance Manditory April 2016 (PDF 97.15 KB) - posted 12.24.2015

Frequently Asked Questions - Former CM2000 Users (PDF 374.68 KB) - posted 11.2.2015

Incorrect or Missing Data Elements Required (PDF 135.2 KB) - posted 11.2.2015

EVV Change Final!! (PDF 95.49 KB) - posted 11.2.2015

EVV Manditory Reminder (PDF 63.94 KB) - posted 10.30.2015

EVV Vendor Selection (PDF 30.99 KB) - posted 10.30.2015

CM2000 Contract End (PDF 106.74 KB) - posted 10.2.2015

EVV Delay in Imposing Compliance Penalties (PDF 38.91 KB) - posted 9.1.2015

Suspension of Visit Maintenance Requirement (PDF 187.32 KB) - posted 8.4.2015

Attend an HHSC EVV Training (PDF 214.03 KB) - posted 6.19.2015

EVV Data Intigrity (PDF 89.78 KB) - posted 6.4.2015

EVV Compliance Plan Updated (PDF 407.1 KB) - posted 5.19.2015

EVV for Community First Choice (PDF 103.9 KB) - updated 6.4.2015

EVV postponed for Private Duty Nurses (PDF 105.03 KB) - posted 5.18.2015    

EVV 21Day Extended (PDF 24.35 KB) - posted 5.1.2015

EVV HHSC Implementation Additional Dates (PDF 41.97 KB) - posted 4.14.2015

EVV HHSC Reason Codes Webinar April 15, 2015 (PDF 21.34 KB) - posted 4.13.2015

EVV HHSC Reason Codes (PDF 154.01 KB) - posted 4.13.2015

EVV HHSC Reason Code Power Point (PPTX 360.1 KB) - posted 4.13.2015

EVV HHSC Announcement. Accectable Telephone Devices (PDF 51.82 KB) - updated 4.13.2015

EVV Fixed Visit Verification Device Santrax (PDF 17.26 KB) - posted 3.25.2015

EVV Provider Implementation Dates 3.6.2015 (PDF 108.22 KB) -  posted 3.18.15

EVV Sandata Notification Update 3.12.2015 (PDF 58.96 KB) -  posted 3.18.15

EVV Provider Alternative Device Notification 3.2015 (PDF 37.63 KB) - posted 3.18.15

EVV Small Device Agreement and Order Form: English (PDF 527.37 KB) - 3.18.15

EVV Small Device Agreement and Order Form: Spanish (PDF 484.52 KB) - 3.18.15

EVV Update: Start date extended (PDF 29.49 KB)

EVV Update: Provider Selection by Feb 10. Default Selection (PDF 44.41 KB)

Updated EVV Announcement (PDF 45.37 KB)

Medicaid Provider Notification: Statewide Implementation of Electronic Visit Verification (PDF 42.62 KB)

Electronic Visit Verification Initiative (PDF 72.42 KB)

Alerts Archives

Medicaid Reenrollment Deadline: Action May Be Required - 3.9.2016

LTSS ACEP Payment Delay Resolved (PDF 64.97 KB) - 2.4.2016

Non-Emergency Transportation Prior Authorization Alert (PDF 262.71 KB) - 1.11.2016

Attendant Rate Increase (PDF 132.06 KB) - 11.4.2015

Community Based Alternative Provider Claims Alert (PDF 62.59 KB) - 10.29.2015

Methylin Authorization Notice (PDF 20.68 KB) - 10.5.2015

TMHP Mandatory Medicaid Reenrollment Workshops Scheduled - 8.19.2015

DADS LTSS Reenrollment Information: Action Required (PDF 22.78 KB) - 8.18.2015

Re-enroll your Texas Medicaid ID: Action Required (PDF 193.08 KB) - 8.18.2015

NDC Unit of Measure Billing Requirement (PDF 62.17 KB) - 7.23.2015

Providers Need to Re-enroll to serve Texas Medicaid Members (PDF 70.34 KB) -7.21.2015

New Prior Authorization Form for all Texas (PDF 65.55 KB) - 7.14.2015

Femoroacetabular Impingement Syndrome Prior Authorization Changes (PDF 61.54 KB) - 6.19.2015

OB/GYN Rate Change (PDF 60.56 KB) - 5.18.2015

HHSC MMP Member Enrollment Rights (PDF 34.91 KB) - 5.7.2015

Medicaid Re-enrollment:  An important message from HHSC (PDF 62.23 KB) - 5.1.2015

UnitedHealthcare Connected (Medicare-Medicaid Program) Town Hall and Webinar Flyer (PDF 121.09 KB) - 4.30.2015

Sinuplasty Required Prior Authorizations (PDF 167.49 KB) - 4.21.2015

UnitedHealthcare Connected (MMP) Authorization Alert (PDF 199.02 KB) - 4.14.2015

NDC Drug Vendor Program Crosswalk (PDF 61.88 KB) - 3.18.2015

MRSAs IDD Authorizations Extended (PDF 65.67 KB) - 4.1.2015

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

TB Testing Alert (PDF 132.95 KB)

New Rates for Personal Assistance and Day Activity Adult Day Care Services – Sept. 1, 2014 (PDF 72.15 KB)
Physical Medicine & Rehabilitation: Multiple Therapy Reduction Policy Reminder (PDF 125.45 KB)
UnitedHealthcare Responds to Ebola Concerns (PDF 80.08 KB)
Online Attachments Now Available (PDF 61.94 KB)
Prior Authorization Change Jan 2015 (PDF 76.93 KB)
Attendant Compensation Rate Enhancement Enrollment Dates Change (PDF 170.21 KB)
NDC Valid Determination (PDF 71.08 KB)
PT.OT.ST. Claims Alert 7.2014 (PDF 60.4 KB)
Use of Electronic Visit Verification for Department of Aging and Disability Services Providers Transitioning to Managed Care Organizations (PDF 83.8 KB)
UPDATE to Statewide Implementation of the Health and Human Services Commission  (PDF 72.42 KB)

New Drug Policy — Went Into Effect on February 15, 2014 (PDF 158.07 KB)
Changes to Your Texas Medicaid Card (PDF 69.21 KB)
Town Hall Flyer (PDF 237.2 KB)
Provider Webinar Flyer (PDF 107.66 KB)
Long Term Services and Support (LTSS) Billing Modifier Changes (PDF 67.41 KB)
Enhanced HIPAA Edits to be applied to Claim Submissions
Changes to Reimbursement Policies (PDF 169.77 KB) - Nov. 16, 2013
New Billing Code for 17-Alpha Hydroxyprogesterone Caproate (PDF 71.84 KB)
T1000 Billing Code Change. Home Health. Skilled Nursing (PDF 68.7 KB)
CHIP Eligibility December 2013 (PDF 63.03 KB)
Readmission Policy (F7001) FAQ (PDF 251.03 KB)
Readmission Policy Reminder (PDF 113.71 KB)
Multiple procedural payment reduction (PDF 97.15 KB) 
Anesthesiologists Payment Alert (PDF 65.8 KB)
Provider Alert (PDF 91.09 KB)
Primary Care Provider Rate Increase (PDF 67.94 KB)
Therapy Rate Reduction (PDF 71.91 KB)
CHIP into Tiers (PDF 89.54 KB)
New and Changed Reimbursement Policies (PDF 135.5 KB) - Sept 14, 2013
Early Child Intervention Claims (PDF 82.75 KB) - March 2013
DME Oxygen and Rentals (PDF 79.07 KB) - Jan. 2013
DME Supplies Documentation Alert (PDF 102.71 KB) - Jan. 2013
DME Diabetic Testing Supplies Benefit Change (PDF 321.25 KB) - Jan. 2013
Drug Claims Change Notification (PDF 75.64 KB) - Dec. 2012
Claim Alert for S5125 (PAS-Provider Attendant Services) Texas STAR+PLUS (PDF 27.33 KB)
Medical Checkups and Sick Visits (PDF 90.16 KB)
Claim Re-submissions (PDF 158.08 KB)
FQHC Claims Alert (PDF 80.95 KB)
RHC Claims Alert (PDF 81.44 KB)
Synagis Program (PDF 81.59 KB)
Respite Claims (PDF 78.21 KB)
Claim Re-Submissions (PDF 158.08 KB)
Webinars 2012-2013 (PDF 239.19 KB)
STAR+PLUS Electronic Claims Submissions (PDF 160.37 KB) - Sep. 28, 2012
Updated Drug Policy - 17P/Makena Injection (PDF 62.53 KB) - 9.23.2015
DME Incontinent Supplies (PDF 62.14 KB)- Aug. 29, 2012
Provider Alert Texas Health Steps Claims (PDF 69.42 KB)- June 29, 2012
UB-04 Billing Alert for Providers (PDF 103.66 KB) - Aug. 7, 2012
Rate Change Notification (PDF 201.43 KB) - May 16, 2012
EFT/ERA Re-Enrollment Letter (PDF 21.44 KB) - April 2012
IMPORTANT NATIONAL ALERT !- Right Fax Issues (PDF 64.98 KB) - Dec. 5 2011
Prohibition of Claims Payment Beyond the Borders of the U.S. (PDF 41.21 KB)
Secure Fax Alert for Medical Prior Authorization Requests (PDF 20.52 KB) - Oct. 2011
Frequently Asked Questions: How to Handle Cost-sharing for UnitedHealthcare Dual Eligible Patients (PDF 61.15 KB)

Payment Policy Notifications

2016

Coding Reminder: How to Report Multiple Surgeons For One Operative Session (PDF 366 KB) - Date Posted 11.29.2016                      

Maximum Frequency per Day and Bilateral Procedures  (PDF 110.98 KB) - Date Posted 11.16.2016

Revision to Lupron Policy-Effective January 1, 2017 (PDF 203.22 KB) - Date Posted 9.19.2016

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 207.51 KB) - 8.3.2016  


New Policy-Evaluation and Management Reimbursement Policy
(PDF 123.41 KB) - 6.23.2016

Phase Two Implementation Delay for Supply Reimbursement Policy (PDF 140.16 KB) - 6.7.2016   

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 282.09 KB) - 5.5.2016 

Facility Billing Policy Update: Reporting an ICD-10 Manifestation Code as a Primary/Principal Diagnosis - Effective July 1, 2016 (PDF 130.9 KB) - 3.29.2016

Adjunct Professional Services Policy-Frequently Asked Questions (PDF 394.35 KB) - 3.7.2016

New Intensity-Modulated Radiation Therapy (IMRT) Reimbursement Policy-Effective July 1, 2016 (PDF 124.56 KB) - 3.1.2016

Claims Processing Change for Eight Professional Reimbursement Policies -Effective May 21, 2016 (PDF 146.62 KB) - 2.17.2016

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 206.33 KB) - 2.17.2016

Changes to Existing Reimbursement Policies-Effective January 1, 2016 and February 13, 2016 (PDF 177.42 KB)

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


2015


Revision to Time Span Codes Policy-Effective November 14, 2015
(PDF 120.33 KB) - 8.6.2015

Reimbursement and Drug Policy Update for ICD-10 (PDF 183.38 KB) - 7.6.2015

2015 Quarter 3 & 4 Updates: Subsequent Revision Delay for the Radiology Multiple Imaging Reduction and Multiple Procedure Policies (PDF 136.23 KB) - 5.27.2015

Procedure to Place of Service and Laboratory Services Reimbursement Policy Updates -Effective August 22, 2015 (PDF 191.23 KB) - 5.12.2015

Reimbursement Policy Clarification for the Maximum Frequency Per Day Policy and Revision Delay for the Radiology Multiple Imaging Reduction and Multiple Procedure Policies (PDF 139.17 KB) - 2.5.2015

New Reimbursement Policies an Changes to Existing Reimbursement Policies-Effective May 16, 2015 (PDF 210.73 KB)

New “X” Modifiers and Impact to UnitedHealthcare Community Plan Reimbursement Policies (PDF 380.15 KB)


2014 and Prior


Changes to Existing Reimbursement Policy and Update to New Reimbursement Policy-Effective Nov. 15, 2014
(PDF 191.17 KB)

Changes to Existing Reimbursement Policies-Effective Sep. 1, 2014 (PDF 232.62 KB)

Reimbursement Policy Changes-Effective Aug. 31, 2014 and New Reimbursement Policies-Effective Sep. 1, 2014 (PDF 195.72 KB)

Changes to Exisiting Reimbursement Policies (PDF 148.56 KB) - May 17, 2014

Changes to Reimbursement Policies (PDF 169.77 KB) - Effective November 16, 2013
Readmission Policy (F7001) FAQ (PDF 251.03 KB)
Readmission Policy Reminder (PDF 113.71 KB)    
New and Changed Reimbursement Policies (PDF 135.5 KB) - Effective Sept 14, 2013
New Payment Policies (PDF 178.82 KB) - Effective November 2012 
Changes to Payment Policies  (PDF 102.73 KB)- Effective November 2012  
New and Changed Reimbursement Policies  (PDF 60.18 KB)- Effective May 2013