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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.

Credentialing Updates: Contact the National Credentialing Center at 1-877-842-3210.


Medical Policy Bulletin 

UnitedHealthcare Community Plan Medical Policy Update Bulletin



Opioid Bulletins 

Reimbursement for Acupuncture Services Frequently Asked Questions (PDF 68.58 KB) - 10.27.2017

New Limits on Prescription Opioids for Acute Pain (PDF 414.09 KB) - 9.21.2017

Opioid Treatment Program Benefit Frequently Asked Questions (PDF 82.73 KB) - 3.24.2017


Current Bulletins 

Frequently Asked Questions for Dual Eligible Special Needs Plan (DSNP) 2018 Expansion (PDF 296.07 KB) - 2.6.2018

New Contact Information for Care Provider Support (PDF 45.48 KB) - 9.5.2017

Incontinence Supplier Change for United Healthcare Community Plan Members (PDF 79.55 KB) - 6.8.2017

Billing Guidance from the Ohio Department of Medicaid Regarding ICD-10 Implementation (PDF 63.79 KB)

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

Delay for the Radiology Multiple Imaging Reduction and Multiple Procedure Policies (PDF 139.15 KB)
Enhanced HIPAA Claim Edits Planned for March 2015 (PDF 173.48 KB)
Bright Futures™ — Our New Standard for Well-Child Care? (PDF 26.63 KB)
Enhanced HIPAA Edits to be applied to Claim Submissions
FAQ for Sleep Test Optimization Program (PDF 126.02 KB)
Frequently Asked Questions: How to Handle Cost-sharing for UnitedHealthcare Dual Eligible Patients (PDF 61.15 KB)
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)
Maternity Admission Notification Update - January 2012 (PDF 27.15 KB)
Occular Screening Medical Policy Cancellation Notice (PDF 23.96 KB)
ODM Guidance Document for Nursing Facilities regarding Patient Liability (PDF 88.5 KB)
Online Password Change (PDF 19 KB)
Plans Notification - Jan. 26, 2012 (PDF 62.42 KB)
Prohibition of Claims Payment Beyond the Borders of the U.S. - Jan. 17, 2012 (PDF 41.21 KB)
Provider Alert: Orencia (abatacept) Reimbursement Policy Change (PDF 31.26 KB)
Provider Notification for November Payment Policy Updates/Changes - Nov. 1, 2012 (PDF 205.73 KB)
Provider Preventable Conditions: Health Care Acquired Conditions and Present on Admission Policy Update (PDF 24.65 KB)
Readmission Policy FAQ (PDF 248.2 KB)
Readmission Policy Reminder (PDF 119.6 KB)
Secure Fax Alert for Medical Prior Authorization Requests - Oct. 12, 2011 (PDF 20.52 KB) (PDF 20.52 KB)
Synagis Program 5 Doses (PDF 51.26 KB)
Synagis Program / Authorization and Product Delivery - Posted October (PDF 52.46 KB)
FAQ – Cost Sharing for Dual Eligible Patients (PDF 39.5 KB)
UnitedHealthcare Sequestration Implementation (PDF 93.07 KB)
United Healthcare Supports National Elder Abuse Awareness Day (PDF 33.22 KB)
UnitedHealthcare Responds to Ebola Concerns
(PDF 80.08 KB)


Community Plan Medical Policy Update - June 2015 (PDF 743.36 KB)


2015 January MyCare Ohio Open Enrollment

Effective January 1, 2015, Ohio Medicaid and Medicare will begin to automatically enroll members in MyCare Ohio plans for both Medicare and Medicaid services. Letters will be sent to dually eligible consumers in early October:

o   Current MyCare Ohio Medicaid-Only members will be notified that they will be automatically enrolled in their current MyCare Ohio plan for Medicare (including Part D prescription drugs) and Medicaid services effective January 1, 2015, unless they request to remain Medicaid Only.   Members enrolled for both Medicare and Medicaid benefits are Dual Benefits MyCare Ohio members

o   Those newly eligible for MyCare Ohio will be provided notice of the requirement to enroll in a MyCare Ohio plan, listing the plan options available in their area.   Individuals who do not call to choose a MyCare Ohio plan will be automatically enrolled in a MyCare Ohio plan that has been pre-selected for them, for both Medicare and Medicaid Benefits. 


MyCare Ohio members may ask providers about enrolling as Dual Benefits or Medicaid Only benefits.  Advantages of Dual Benefits, integrating both Medicare and Medicaid services include: 

o   Providers bill one payer for Medicare and Medicaid benefits

o   The MyCare Ohio plan is the single source for member and provider information regarding Medicare and Medicaid benefits

o   Plans provide 24-hour access to Care Management, Behavioral Health Crisis and Nurse Advice lines


If members have questions about choosing a MyCare Ohio plan or about enrollment options, refer them to the Ohio Medicaid Consumer Hotline at (800) 324-8680.

Providers who do not have contracts with MyCare Ohio plans may be able to provide services to current patients/clients for a “transition period”. 

Physicians who are not contracted with MyCare Ohio plans may continue to serve MyCare Ohio Dual Benefits members for a period of one year after enrollment. 

MyCare Ohio plan networks are also open to new physician contracts at this time.  Contact the plans’ provider services with questions: 


MyCare Ohio Plan

Toll Free Provider Services Phone Number

MyCare Ohio Plan Website Address




Payment Policy Notifications

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

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

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

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)

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)

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

Procedure to Place of Service and Laboratory Services Reimbursement Policy Updates-Effective August 22, 2015 (PDF 191.37 KB)

Reimbursement Policy Clarification for the Maximum Frequency Per Day Policy and Revision  (PDF 139.15 KB)

Changes to Existing Reimbursement Policies-Effective May 2015
(PDF 206.2 KB)
REVISED: New “X” Modifiers and Impact to UnitedHealthcare Community Plan Reimbursement Policies
(PDF 380.73 KB)
New “X” Modifiers and Impact to UnitedHealthcare Community Plan Reimbursement Policies
(PDF 376.83 KB)
Physical Medicine & Rehabilitation: Multiple Therapy Reduction Policy Reminder
(PDF 24.38 KB)
New Reimbursement Policies and Changes to Existing Reimbursement Policies-Effective Feb. 14, 2015 and Mar. 1, 2015
(PDF 211.02 KB)
Changes to Existing Reimbursement Policy and Update to New Reimbursement Policy-Effective Nov. 15, 2014 (PDF 192.84 KB)

Changes to Existing Reimbursement Policies ‒ Effective Aug. 1, 2014
(PDF 233.28 KB)
Reimbursement Policy Changes-Effective Aug. 23, 2014 and New Reimbursement Policies-Effective Sept. 1, 2014 (PDF 195.28 KB)

Changes to Existing Reimbursement Policy – Effective May 17, 2014 (PDF 148.09 KB)

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

New Medical Policy and Changes to Reimbursement Policies - Effective November 16, 2013 (PDF 174.08 KB)

New and Changed Reimbursement Policies  - Effective Sept. 14, 2013
(PDF 135.2 KB)
New and Changing Reimbursement Policies - Effictive May 18, 2013 (PDF 56.18 KB)

New Vaccines for Children Policy - Effective May 18, 2013 (PDF 43.89 KB)

Changes to Reimbursement Policies – Effective Feb. 12, 2012 (PDF 45.12 KB)

New Policies Effective Aug. 14, 2011 (PDF 65.09 KB)