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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.

 

Verifying Authorizations for HCBS Waiver Members Who Transitioned from AmeriHealth (PDF 313.83 KB) - 12.20.2017

Private Duty Nursing Prior Authorization Reminders (PDF 66.14 KB) - 12.15.2017 

Requesting Full Member Supports Intensity Scale (SIS) Data (PDF 52.47 KB) - 11.27.2017

Information for Consumer Directed Attendant Care (CDAC) Providers Who Serve Members Transitioning to UnitedHealthcare Community Plan (PDF 55.11 KB) - 11.10.2017

Intellectual Disability (ID) Waiver Tiered Rates & Coding Changes for 1915(i) Habilitation Waiver (PDF 54.76 KB) - 11.03.2017

Policy Update for Home and Vehicle Modifications (PDF 48.53 KB) - 11.03.2017

Claim Submission Tips for HCBS and Habilitation Service Providers (PDF 51.72 KB) - 11.03.2017

Peer Support Services No Longer Require Prior Authorization (PDF 56.66 KB) - 10.13.2017

Billing Reminders for Federally Qualified Health Centers (FQHCs) and Rural Health Centers (RHCs) (PDF 76.22 KB) - 7.20.2017 | Updated 11.03.2017

Billing Reminder for Ambulance Services (PDF 48.25 KB) - 7.14.2017

Billing Reminder for Physician Assistants and Advanced Registered Nursing Practitioners (PDF 53.43 KB) - 6.5.2017

Guidelines for Non-Emergent Emergency Room (ER) Visits (PDF 58.61 KB) - 5.28.2017

Billing Reminder for HCBS Waiver Transportation (PDF 46.39 KB) - 5.1.2017 

Billing Reminder for Psychiatric Medical Institutions for Children (PMICs) (PDF 46.75 KB) - 4.5.2017

Cotiviti Healthcare to Conduct High-Cost Medication Claims Reviews  (PDF 49.7 KB)- 6.10.2017

Durable Medical Equipment Claim Submission Tips (PDF 50.98 KB) - 3.20.2017

Routine Podiatry Services Claims Submission Tips (PDF 153.75 KB) - 2.01.2017

Immediate Reprocessing Notification for Emergency Room (ER) Visit Claims (PDF 39.85 KB) - 12.23.2016

Client Participation Clarification for HCBS Services and Institutional Settings (PDF 45.58 KB)

Billing Reminders for Home Health Services (PDF 49.21 KB) - 9.1.2016 

Billing Reminder for Hospice Services (PDF 68.58 KB) - 8.2.2016

Billing Reminder for CDAC Service Providers (PDF 73.78 KB) - 5.16.2016

 

Payment Policy Notifications

 

Reimbursement Policy Updates (PDF 90.82 KB) - 6.6.2018

Update to National Drug Code (NDC) Policy: Hospital Outpatient Facility Drug Claims (PDF 777.74 KB) - 5.25.2018

Important Reimbursement Reminder for Duplicate or Repeat Services of Global Test Only Codes (PDF 745.2 KB) - 5.4.2018

Drug Testing Reimbursement Policy FAQs (PDF 53.34 KB) - 4.19.2018

Understanding Our Supply Reimbursement Policy (PDF 740.87 KB) - 4.19.2018

Reimbursement Change for Image Guidance Code 77014 (PDF 740.33 KB)  - 3.9.2018

Revision to Laboratory Services Reimbursement Policy (PDF 750.09 KB) - 2.28.2018

Reimbursement Notice for Multiple Procedure Reduction Codes (PDF 762.75 KB) - 1.31.2018

Important Reimbursement Change to Ambulance Reimbursement Policy (PDF 747.29 KB) - 1.26.2018

New Observation Services Facility Policy - Effective May 1, 2018 (PDF 743.75 KB) - 1.26.2018 

Policy Reminder: Reimbursement for Laboratory Claims (PDF 769.75 KB) - 1.5.2018

Revenue Codes Requiring Procedure Codes Reimbursement Policy Clarification for Care Providers at Facilities and Hospitals (PDF 66 KB) - 11.29.2017 

Reimbursement Change for Image Guidance Code 77014 (PDF 66 KB) - 11.29.2017

Ambulance Reimbursement Policy Coding Guidelines Reminder and Policy Changes for 2018 (PDF 57.68 KB) - Date Posted 10.26.2017

New Add-On Codes Facility Policy - Effective Feb. 1, 2018 (PDF 54.38 KB) - Date Posted 10.20.2017 

Drug Testing Reimbursement Policy Update - Effective Jan. 1, 2018 (PDF 68.64 KB) - Date Posted 10.5.2017

National Drug Code Requirements for UnitedHealthcare Community Plan Professional Claims Frequently Asked Questions (PDF 140.38 KB) - Date Posted 8.22.2017

Reimbursement Change for Prolonged Services Policy (PDF 67.01 KB) - Date Posted 8.18.2017

Claim Reprocessing for Rebundling Code 96160 (PDF 48.51 KB) - Date Posted 7.27.2017

Revision to the Intrauterine Device (IUD) Supply Policy (PDF 52.8 KB) - Date Posted 7.12.2017

UnitedHealthcare Community Plan Bilateral Procedures and Maximum Frequency Per Day Policies – Effective Nov. 11, 2017 (PDF 49.38 KB) - Date Posted 6.28.2017

Two Place-of-Service (POS) Codes Added to Facility POS Code List in Two Policies (PDF 54.97 KB) - Date Posted 6.23.2017

New Drug Testing Reimbursement Policy Effective Sept. 1, 2017 (PDF 120.5 KB) - Date Posted 5.31.2017

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

UnitedHealthcare Community Plan Medicare Claims Processing System Is Being Upgraded – Effective May 20, 2017 (PDF 39.84 KB) - Date Posted 4.6.2017

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

New National Drug Code Requirement Policy– Effective May 1, 2017 (PDF 48.37 KB)

Implementation of the new Clinical Laboratory Improvement Amendments Identification Requirements Policy and the Replacement Codes Policy - Effective August 1 and November 1, 2016. (PDF 207.51 KB)

Changes to the Non-Covered Codes, Ambulance, and Nonphysician Health Care Professionals Billing Evaluation and Management Codes Policies - Effective November and December 2016  (PDF 207.51 KB)

Coding Reminder: How to Report Multiple Surgeons For One Operative Session (PDF 732.37 KB)

Revision to Maximum Frequency per Day and Bilateral Procedures Policies for Procedure Codes with Bilateral Surgery Indicator of “2” - Effective February 12, 2017 (PDF 125.61 KB)

Policy Change for the Multiple Procedure Payment Reduction of Diagnostic Imaging Services - Effective January 1, 2017  (PDF 351.3 KB)

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)

New Policy-Evaluation and Management Reimbursement Policy (PDF 123.16 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)

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