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Bulletins and 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 Update Bulletin 

UnitedHealthcare Community Plan Medical Policy Update Bulletin

 

Current Bulletins

Hospital Service Payment Increase - Effective Aug. 24, 2018 - 08.14.2018 

Provider Education Meetings about KanCare 2019 - 08.13.2018 

Preferred Drug List Updates - 08.02.2018

New and Established Patient Billing for CMHCs - 08.02.2018

Tobacco Cessation Counseling - 08.02.2018

Provider Enrollment Managed Care Regulation Implementation Update - 08.02.2018

Modifier QL Update - 08.02.2018

Home and Community-Based Services Care Provider Billing Guide Now Available (PDF 1.28 MB) - 07.272018 

Prior Authorization (PA) Updates - Effective June 15, 2018 - 7.26.2018

Update to Modifier 73 - 07.17.2018 

Indian Health Services 2018 Rate - 7.13.2018

Coverage for GJ-Tube - 7.11.2018 

Special Notice Regarding Nursing Facility Ventilator Dependents - 7.9.2018 

Covered Codes for Bed Frames - 7.9.2018

Pharmacy Prior Authorization and Preferred Drug List (PDL) List - 7.9.2018 

Rate Increase for Long-Acting Reversible Contraceptives (LARC's) - 6.29.2018

Covered Telemedicine Services Codes - 6.29.2018

Covered Telemedicine Services Codes - 6.26.2018

July 2018 HCPCS Updates - 6.26.2018

Covered Anesthesia Code for Dental Procedures - 6.26.2018

REMINDER: Appeals Process 06/08/2018 - 6.15.2018

Coverage of Vaccine Codes - 5.30.2018 

Covered Treatment for Chronic Migraine - 5.30.2018 

REMINDER: Mental Health Medication Emergency Supply - 5.24.2018

HCBS 2019 Reimbursement - 5.24.2018

Opioid Products Indicated for Pain Management: Prior Authorization Grandfathering Process - 5.17.2018

Influenza Virus Vaccine  - 5.17.2018

NCCI MUEs Quarterly Update  - 5.17.2018

KanCare All MCO HCBS Training  - 5.17.2018

Team Surgery - 5.14.2018 

UPDATED Reminder: Obstetrical (OB) Sonograms - 5.10.2018 

Reminder: Appeals Process - 5.10.2018 

Revision of the MS-2126 Form - 5.10.2018

Coverage of Sedation Codes - 5.2.2018

Reminder: Long-Acting Reversible Contraceptives (LARC) Recommendations - 5.2.2018

Long-Acting Reversible Contraceptives - 4.30.2018

Non-Emergency Medical Transportation (NEMT) Codes - 4-25-2018

Present on Admission (POA) Requirements - 4.25.2018

REMINDER: Appeals Process - 4.25.2018

Opioid Products Indicated for Pain Management - 4.27.2018

Gene Expression Profiling - 4.19.2018

Preferred Drug List Update - 4.17.2018

April 2018 HCPCS Drug Updates - 4.17.2018

Authentication of Documentation - 4.17.2018

National Correct Coding Initiative (NCCI) Editing - 4.17.2018

Psychiatric Residential Treatment Facility (PRTF) Level of Care - 4.12.2018

Vagus Nerve Stimulation Therapy - 4.12.2018

CMS Medical Unlikely Edits (MUE) and Procedure-to-Procedure (PTP) Edit Corrections - 4.12.2018

April 2018 HCPCS Updates - 4.12.2018

Preferred Drug List Update - 4.2.2018

Updated 2018 Anesthesia Conversion Factor 3.29.2018

April 2018 HCPCS Update 3.29/2018

New Medicare Cards - 3.26.2018

Gabapentin and Pregabalin Updates - 3.20.2018

Preferred Drug List Update - 3.16.2018 

Pharmacy Prior Authorization Updates - 3.16.2018 

Expanded Age Range - 3.16.2018 

Authentication of Documents - 3.16.2018 

KanCare MCO Training - 3.13.2018 

2018 Swing Bed Rates - 3.9.2018 

Prescribing Opioids - 3.7.2018

Updated MCO Provider Reconsideration Process  - 3.7.2018

Updated MCO Provider Appeal Process  - 3.7.2018

Crisis Intervention Services - 3.5.2018 

Potential Fraud Alert: Solicitation by Medical Equipment Suppliers - 3.5.2018 

Pharmacy Prior Authorization Forms - 3.1.2018

Telemedicine Update - 3.1.2018 

National Correct Coding Initiative (NCCI) Medically Unlikely Edits (MEU) Quarterly Update - 3.1.2018 

Updated: HCBS Provider Billing Guide (PDF 62.68 KB) - 2.27.2018 

Gene Expression Profiling - 2.26.2018

ER Codes and Modifiers - 2.26.2018

CMHC Claims - 2.26.2018

Telemedicine Update - 2.15.2018

Readmission Criteria - 2.13.2018

Rate Increase for Select Noninvasive Vascular Codes - 2.08.2018

Medicare Crossover Claim Processing Changes Post-Implementation Update - 2.08.2018

Preferred Drug List Update - 2.08.2018

NEMT Codes - 2.08.2018

Covered Codes for Fetal Testing - 2.08.2018

New Covered Service - 2.08.2018

HCBS Provider Qualifications - 1.29.2018 

Physician and Federally Qualified Health Center (FQHC) or Rural Health Clinic (RHC) Services - 1.29.2018

2017

Emergency Room Visits Billed with Non-Emergent Diagnosis - 1.25.2018

Debridement Code Covered - Effective March 1, 2018 - 1.25.2018 

Provider Enrollment Application Wizard Training - 1.19.2018

KMAP Provider Enrollment System Upgrade - 1.16.2018 

Preferred Drug List Update - 1.3.2018

Medicare Part D Copayment Assistance Amount - 1.3.2018

Provider Application Fee Update - 1.3.2018

Fiscal Year 2018 Medicare Severity Diagnosis Related Groups (MS-DRGs) - 12.29.2017 

New Modifiers for Drugs - 12.29.2017 

PRTF Reserve Days - 12.29.2017 

Provider Enrollment Managed Care Changes - 12.27.2017 

Replacement Procedure Code for 97532 - 12.27.2017 

Home and Community Based Services (HCBS) Intellectual and Developmental Disability (I/DD) Specialized Medical Care - 12.27.2017

2018 HCPCS Updates - 12.27.2017

2018 HCPCS CDT Updates - 12.27.2017

2018 HCPCS Modifier Updates - 12.27.2017

Anesthesia Conversion Factor - Effective Jan. 1, 2018 - 12.20.2017

Screening, Brief Intervention and Referral for Treatment - 12.18.2017

NCCI MUE’s Quarterly Update - 12.11.2017

Community Mental Health Centers (CMHC) Codes and Modifiers - 12.5.2017 

Medicare Crossover Claims Provider Opt-Out Changes - 11.29.2017

Medicare List of Unacceptable Principal Diagnosis Codes Update - 11.29.2017

NDC Search Results Update - 11.29.2017

Provider Enrollment  Managed Care Changes - 11.27.2017

Medicaid Managed Care Organization (MCO) 340B Policy - 11.21.2017

Preferred Drug List Updates - 11.21.2017

Updated: Pharmacy Medication Fill Requirement - 10.30.2017

Updated: HCBS Provider Billing Guide (PDF 62.68 KB) - 10.11.2017

Updated: Billing for Code 99211 - 10.09.2017

Physician Assistants (PA’s) and Advanced Practice Registered Nurses (APRN’s) in Multispecialty Clinics - 10.09.2017

Medicare Severity Diagnosis-Related Groups (MS-DRGs) Grouper Version 35 - 10.3.2017

Prior Authorization Required for Medications - 10.02.2017

HCPCS October 2017 Updates - 10.02.2017

Federal Fiscal Year (FFY) 2018 Payment Rates - 10.02.2017

Other Insurance Verification - 9.25.2017 

Annual Attestation Requirement - 9.25.2017

Work Opportunities Reward Kansans (WORK) Program Manual Update - 9.21.2017

National Correct Coding Initiative (NCCI) and Medically Unlikely Edits (MUEs) Quarterly Updates - 9.18.2017

Prior Authorization for Mental Health Drugs - 9.18.2017

Implementation of Fingerprint-Based Criminal Background Checks Update - 9.8.2017

Kansas Department for Aging and Disability Services (KDADS) Adverse Incident Reporting (AIR) System - 9.5.2017

All MCO Training - 9.5.2017

Prior Authorization Required for Medications - 9.5.2017

Reminder: Claim Recoupment - 8.29.2017 

Mid-Level Providers in a Community Mental Health Center (CMHC) - 8.17.2017

Updated: Crisis Intervention Services - 8.16.2017 

Code A9606 No Longer Considered Content of Service - 8.9.2017

Medicare Crossover Claim Processing Changes - 8.9.2017 

Place-of-Service (POS) Code for Professional Services in a Free-Standing Psychiatric Facility - 8.8.2017

Prior Authorizations Required for Medications - 8.8.2017

Updated: HCBS Reimbursement - 7.24.2017

Updated: Out of State Outlier CCR - 7.18.2017

Mental Health Medication Emergency Supply - 7.19.2017

KanCare All Managed Care Organziation (MCO) Home and Community Based Services (HCBS) Training - 7.11.2017

Provider Application Fee Update - 7.11.2017

Updated: Billing for Code 99211 - 7.11.2017

Budget Reduction Restoration - 7.6.2017 

Home and Community Based Services (HCBS) Intellectual/Developmentally Disabled (I/DD) Supportive Home Care - 7.6.2017

Home and Community Based Services (HCBS) July 2017 Updates - 7.6.2017 

Updated: Psychiatric Residential Treatment Facility (PRTF) Admission Assessment - 7.6.2017 

Updated: Wheelchair Seating Assessments - 7.6.2017 

National Drug Code (NDC) Search Results Issue - 6.28.2017

Psychiatric Residential Treatment Facility (PRTF) Admission Assessment - 6.28.2017

Wheelchair Seating Assessments - 6.28.2017

Inpatient Hospital Utilization Review - 6.26.2017

Psychiatric Observation - 6.22.2017

Home and Community Based Services (HCBS) Intellectual/Developmentally Disabled (I/DD) Reassessments - 6.22.2017

Crisis Intervention Services - 6.22.2017

Additional State Plan Services - 6.19.2017

KanCare Maintenance Medications - 6.19.2017

National Correct Coding Initiative (NCCI) and Medically Unlikely Edits (MUEs) for Code Deactivated - 6.15.2017

Kansas Medicaid Adoption of the Medicare List of Unacceptable Principal Diagnosis Codes - 6.15.2017

Revision of the MS-2126 - 6.12.2017

National Correct Coding Initiative (NCCI) and Medically Unlikely Edits (MUEs) Quarterly Updates - 6.6.2017

MCO Critical Access Hospital Adjustment Factor - 6.6.2017

Discontinued Revenue Code - 6.6.2017

HCBS Provider Billing Guide (PDF 77.49 KB) - 6.5.2017

Provider Input Period for KanCare Renewal - 6.5.2017

Public Notice and Comment Period for KanCare Extension - 6.2.2017

MCO Provider Appeal Process - 6.2.2017

New Clinical Information System (PDF 65.1 KB) - 5.26.2017

Rate Adjustments - 5.26.2017

Medication Prior Authorization - 5.26.2017

Home Health Services - 5.26.2017

Billing for Code 99211 - 5.23.2017 

Institutional Hospital Credit Balance Audits Continue - 5.23.2017

MCO Reconsideration Process - 05.03.2017

Updated Kansas Organizational Provider Credentialing/Recredentialing Application - 4.26.2017

Consolidated Publication Process - 4.26.2017

Claim Reconsideration, Appeal and State Fair Hearing Process (PDF 105.78 KB) - 5.3.2017

Autism Services Updates - 3.31.2017

MCO Quick Reference Guide (PDF 222.72 KB) - 3.30.2017

Covered Procedure Code - 3.28.2017 

CMHC Only Code Part A - 3.27.2017

CMHC Only Code Part B - 3.27.2017

PRTF Reserve Days - 3.27.2017

KanCare All MCO Training Sessions - 3.15.2017 

Extraordinary Funding (PDF 346.51 KB) - 3.10.2017

Reporting Requirements Reminder for Home Telehealth, Nurse Evaluation Visit and Wellness Monitoring (PDF 318.59 KB) - 3.9.2017 

Psychiatric Residential Treatment Facility Billing Instruction - 3.3.2017

Intrauterine Device Rate Increase - 3.3.2017

MS-DRG Grouper Version 34 Implementation and Processing - 2.23.2017

Adverse Incident Management (PDF 157.75 KB) - 2/22/2017 

Medicare Crossover Claim Processing Changes  1/30/2017

Radiation Therapy Codes 2/1/2017

UB-04 Dates 1/17/17

Catheter Aspiration Coverage 1/10/2017

Coverage of 99211 by Registered Nurse (PDF 40.78 KB)  1/6/2017

Updated Coverage Information - FluMist 1/6/2017

Modifier JW Requirements 1/6/2017

Medicare Part D Copayment 1/6/2017

Rates Subject to Budget Reduction  1/3/2017

2017 HCPCS Updates  1/3/2017 
 

2016

Services Considered Content of Service (PDF 45.15 KB)  12/28/2016

HCBS Updates – Enhanced Care Services  12/28/2016

HCBS I/DD Crisis and Exception Process Updates  12/23/2016

2017 Anesthesia Conversion Factor  12/19/2016

MS-DRG Updates  12/19/2016

NCCI MUE Quarterly Updates  12/19/2016

October 2016 ICD-10 Implementation  12/19/2016 

CMHC Billing for Repeat Services 12/13/2016

October 2016 HCPCS Updates  12/13/2016

Surgical Procedures and Sterilization Form Requirements  12/1/2016

IDD Residential Billing Changes (PDF 108.74 KB)  11/29/2016 

Additional Covered Codes  10/25/2016 

Budget Payment Reduction for Out-of-State Providers  10/26/2016

MS-DRG Grouper Version 34  10/7/2016

New HCBS TBI Forms  10/7/2016

Medicare List of Unacceptable Principal Diagnosis Codes  10/7/2016

Codes to Use for New VFC - Covered Flu Vaccine  9/20/2016

Procedure Code Q5101 and Modifier ZA  8/8/2016

July 2016 HCPCS Updates  8/8/2016

Kansas Budget Reductions - Bulletin 16111, 1612816125   7/27/2016 

Anesthesia Procedures  7/18/2016 

Unacceptable Primary Diagnosis Codes  7/18/2016 

KanCare HCBS All MCO Training  7/13/2016

Content of Service Codes  7/13/2016

NEW Live Webcast Friday, July 15: Health Care for Adults with Intellectual and Developmental Disabilities (PDF 219.8 KB)

Third-Party Liability Noncovered Procedure Cost List  6/27/2016

Donor Human Breast Milk (PDF 181.4 KB)  6/27/2016

Removing Authorizations Limits for Behavioral Health (PDF 41.53 KB)

Enhanced Care Services (PDF 41.27 KB)  5/3/2016

April 2016 HCPCS Updates (PDF 41.27 KB)  4/28/206

Provider Training Sessions May 17 in Overland Park and May 24 in Wichita. Click here for details. (PDF 318.37 KB)

KanCare NPI and Modifier Billing Requirements for CMHC's (PDF 237.66 KB)  4/27/2016

KBH-EPSDT Updates  4/27/2016

Overnight Respite Update  4/5/2016

Revised Hospital Rates  4/1/2016

HCPCS 2016 Updates  3/27/2016

HCBS Client Obligation Provider Notification (PDF 67.91 KB)  3/27/2016

Process for Newborn Services Billed Under the Mother’s Beneficiary ID (PDF 45.21 KB)  3/23/2016

Health Homes Program Discontinued (PDF 16.36 KB)  3/17/2016

Prior Authorization Required  3/17/2016

Prior Authorization Required (Ages 0-13)  3/17/2016

OB Sonogram Coverage  3/14/2016

Date of Death  3/4/2016

Hospital Outpatient Clinic Visit Services Update (PDF 60.54 KB)   3/1/2016 

KAN Be Healthy Updates  2/15/2106

Facility Charges (G0463) Non-Coverage Update (PDF 31.38 KB)  2/15/2016

Community Based Services Treatment Team Reimbursement (PDF 52.83 KB)  2/5/2016

New Rates for Sleep Cycle Support Services (PDF 211.72 KB)  2/3/2016

Updated Billing Process for MFP Transitional Services (PDF 48.28 KB)  2/2/2016

2016 MS-DRG Weights and Rates (PDF 46.83 KB)  1/28/2016

2016 Anesthesia Conversion Factor Update  1/26/2016

Personal Care Services Updates  1/15/2016

Hospital Outpatient Clinic Visit Code Coverage  1/7/2016

Home Health Agency and Hospice Skilled Nursing Visits*   1/5/2016
*Important: Though the effective date listed on the KMAP bulletin is Jan. 1, 2016, our effective date will be Feb. 1, 2016.

Hospice Updates *   1/5/2016
*Important: Though the effective date listed on the KMAP bulletin is Jan. 1, 2016, our effective date will be Feb. 1, 2016.

2016 Anesthesia Conversion Factor  1/4/2016

 

 

 

Payment Policy Notifications

Upgrade to UnitedHealthcare Community Plan Claims Editing System (PDF 756.24 KB) - 8.1.2018

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

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

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 216.66 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 48.38 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

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)