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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.

 

Maryland Provider Bulletins 

UnitedHealthcare Community Plan of Maryland Preferred Laboratory Services Protocol (PDF 877.6 KB) - 5.14.2018

Provider Directory Search Upgrade (PDF 70.78 KB) - 4.13.2018

Referral Information - Quick Reference Guide (PDF 129.39 KB)

Referrals Frequently Asked Questions (PDF 94.96 KB) - 4.13.2018

Now Accepting Retroactive Referrals Within Five Calendar Days of the First Specialist Visit (PDF 88.98 KB) - 4.13.2018

Emergency Room Auto-Pay List – Effective June 1, 2018 (PDF 941.51 KB) - 3.1.2018

The E2 Strategy: Shared Decision Making (PDF 65.38 KB) - 2.16.2018 

Understanding Cultural Competency and the Americans with Disabilities Act (PDF 81.89 KB) - 1.18.2018 

Medicaid Managed Care Rule Presentation (PDF 90.71 KB) - 1.8.2018

Medicaid Managed Care Rule Update Frequently Asked Questions (PDF 81.15 KB) - 12.22.2017

Injury Coverage Coordination Program (PDF 265.32 KB) - 12.22.2017

HealthChoice Provider Enrollment Requirement Frequently Asked Questions (PDF 38.28 KB) - 12.15.2017

HealthChoice Provider Enrollment Requirement Starting Jan. 1, 2018 (PDF 74.93 KB) - 12.14.2017 

2017 UHC CAHPS® 5.0H Adult Medicaid Survey Reports (PDF 85.28 KB) - 12.13.2017

2017 UHC CAHPS® 5.0H Child Medicaid (with CCC) Survey Reports (PDF 94.36 KB) - 12.13.2017

2017 Provider Satisfaction Survey Summary Report (PDF 140.78 KB) - 12.12.2017

2017-2018 Outreach Program Plan (PDF 467.21 KB) - 12.6.2017 

Care Provider Quick Reference Guide (PDF 50.91 KB) - 12.1.2017

The E2 Strategy: Shared Decision Making (PDF 65.38 KB) - 12.1.2017

Helping Patients Better Understand Asthma Medication Ratio (PDF 52.57 KB) - 12.1.2017

Adult Dental Services (PDF 41.84 KB) - 12.1.2017

Expanded Reconsideration Process Includes Medical Necessity Claim Denials (PDF 44.28 KB) - 11.27.2017

Emergency Room Auto-Pay List (PDF 1.08 MB) - 11.21.2017

New Periodicity Schedule for EPSDT Screenings (PDF 55.86 KB) - 11.03.2017

Maryland Department of Health and Mental Hygiene 2016 Fatal Overdose Report (PDF 354.88 KB) - 11.01.2017 

Skilled Nursing Facility Stays Frequently Asked Questions (FAQs) (PDF 61.36 KB) - 10.02.2017

Postpartum Infant and Maternal Referral Form (PPTX 8.4 MB) - 10.2.2017

STAT Outpatient Laboratory Services Exception List (PDF 91.08 KB) ‒ Updated 9.01.2017 - Posted 9.22.2017

Opioid Tapering Recommendations (PDF 74.75 KB) - 9.21.2017 

Urgent Care Centers: Update to Reimbursement Policy for S9083 - Effective Dec. 1, 2017 (PDF 82.78 KB) - 9.1.2017

MyHealthLine Bulletin (PDF 49.45 KB) - 9.1.2017

Medicaid Managed Care Rule External FAQ’s (PDF 64.57 KB)

Medicaid Managed Care Rule Presentation (PDF 90.71 KB)

Opioid Prescription Policy Changes Webinars and Case Management Services for HealthChoice Members (PDF 268.87 KB) - 8.8.2017

Case Management Services for HealthChoice Members (PDF 35.74 KB) - 8.1.2017

Quantity Limits for Opioids (PDF 132.82 KB) - 6.28.2017 

Opioid Policy Changes (PDF 54.59 KB) - 6.22.2017 

2016 - 2017 Outreach Program Plan (PDF 382.92 KB) - 6.19.2017

Maryland Opioid Prescribing Policies (PDF 56.8 KB) - 6.19.2017

2016 CAHPS® 5.0H Adult Medicaid Initial Survey Reports (PDF 85.64 KB) - 6.19.2017

2016 CAHPS® 5.0H Adult Medicaid Survey Reports (PDF 201.22 KB) - 6.20.2017

2016 CAHPS® 5.0H Child Medicaid (with CCC) Survey Reports (PDF 188.67 KB) - 6.20.2017

Specialty Pharmacy Program Changes Starting June 26, 2017 (PDF 36.68 KB) - 6.14.2017

Beacon Health Options Bulletin (PDF 609.62 KB) - 6.08.2017 

UnitedHealthcare On My Way Website (PDF 48.33 KB) - 6.08.2017

Care Provider Quick Reference Guide (PDF 49.29 KB) - 6.02.2017

 

Helping Patients Better Understand Asthma Medication Ratio (PDF 18.9 KB) - 5.01.2017 

2017 Quality Outreach Program Plan (PDF 338.15 KB) - 5.22.2017

Helping Patients Better Understand Asthma Medication Ratio (PDF 18.9 KB) - 5.01.2017 

Opioid Policy Change Notice from Maryland Department of Mental Health and Hygiene (PDF 27.65 KB)- 4.03.2017

Opioid Prescribing Policies - Effective July 1, 2017 (PDF 127.32 KB) - 4.03.2017 

Opioid Policy Change Notice from Maryland Department of Mental Health and Hygiene (PDF 27.65 KB) - 4.03.2017

STAT Outpatient Laboratory Services Exception List for Referral Process Change ‒ Updated Jan. 1, 2017 (PDF 78.52 KB) - 06.02.2017

24-Hour Limit for Hospital Outpatient Observation Stays - Effective Jan. 1, 2017 (PDF 43.08 KB) - 2.01.2017

Claims Recoupment Policy Update - Effective Jan. 1, 2017 (PDF 62.78 KB) -  1.11.2017 

Benefit Coverage Changes for Long-Acting Opioids (PDF 76.42 KB) - 12.29.2016

2016 Provider Satisfaction Analysis Report (PDF 89.93 KB) - 12.27.2016

2016 Adult CAHPS Analysis Report (PDF 64.15 KB) - 12.27.2016

2016 Child CAHPS Analysis Report (PDF 76.89 KB) - 12.27.2016 

Additional Audit Requirements for Facility Claims (PDF 47.39 KB)

Coverage of Gender Dysphoria Related Services  (PDF 119.8 KB)

 

Payment Policy Notifications

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) - Date Posted 11.29.2017 

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

New Drug Testing Reimbursement Policy Effective Sep. 1, 2017 (PDF 52.38 KB) - Date Posted 6.19.2017

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 216.94 KB) - Date Posted 4.07.2017

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

Claims Recoupment Policy Update – Effective Jan. 1, 2017 (PDF 62.84 KB)

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

UnitedHealthcare Community Plan Added to Electronic Payments & Statements (PDF 59.89 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) - 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)