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

 

Medical Policy Bulletin

UnitedHealthcare Community Plan Medical Policy Update Bulletin

 

Current Bulletins

Guide to UnitedHealthcare Community Plan of Pennsylvania Clinical Programs (PDF 80.81 KB) - Date Posted 3.8.2018

Updates to the 2017 Early and Periodic Screening, Diagnosis and Treatment (EPSDT) Program Periodicity Schedule (PDF 853.83 KB) - Date Posted 1.8.2018

Care Provider Fraud, Waste and Abuse Education and Corrective Action Plan Information (PDF 85.11 KB) - Date Posted 12.20.2017

Changes to Long-Acting Opioid & Short-Acting Opioid Policies for UnitedHealthcare Community Plan Members - Effective December 27, 2017 (PDF 72.24 KB) - Date Posted 12.20.2017

Electronic Provider Enrollment Application for CHIP Providers - Effective Nov. 17, 2017 (PDF 148.62 KB) - Date Posted 11.21.2017 

Update to Reimbursement Policy for Urgent Care Centers Billing HCPCS Codes S9083 and S9088 – Effective Feb. 1, 2018 (PDF 81.82 KB) - Date Posted 11.15.2017

Provider Training: Electronic Provider Enrollment Application User Interface Training for Children’s Health Insurance Program (CHIP) Providers (PDF 94.82 KB) - Date Posted 10.27.2017

Revisions to the Early and Periodic Screening, Diagnosis and Treatment (EPSDT) Program Periodicity Schedule (PDF 491.24 KB) - Date Posted 10.18.2017

CHIP Provider Enrollment Information (PDF 444.66 KB) - Date Posted 9.27.2017

2017 Physician Satisfaction Survey Reminder (PDF 92.32 KB) - Date Posted 9.21.2017 

School Vaccination Requirements for Attendance in Pennsylvania Schools (PDF 2.08 MB) - Date Posted 8.4.2017

2017 Recommended Childhood and Adolescent Immunization Schedule (PDF 287.35 KB) - Date Posted 7.06.2017 

Specialty Pharmacy Program Changes - Effective June 26, 2017 (PDF 64.11 KB) - Date Posted 6.29.2017

Pennsylvania EPSDT Quick Reference Guide (PDF 155.84 KB) - Date Posted 06.28.2017

Medical Assistance Care Provider Reminder: Valid PROMISe License Required (PDF 45.82 KB) - Date Posted 06.28.2017

Provider Screening of Employees and Contractors for Exclusion from Participation in Federal Health Care Programs and the Effect of Exclusion on Participation - Date Posted 05.05.2017

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

Medical Assistance Program Fee Schedule Updates for Long Acting Reversible Contraceptives (LARC) and Certain Family Planning Services (PDF 305.9 KB) - Date Posted 02.17.2017

Environmental Lead Investigations Bulletin

Reportable Diseases Reminder (PDF 159.31 KB)

CDC Recommendations for HPV Shots for Younger Adolescents

Pennsylvania’s Telephonic Psychiatric Consultation Service Programs (TiPS) Quick Reference Guide (PDF 191.21 KB)

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

Diabetes Self-Management Education Provider Toolkit (PDF 1.22 MB)

ABAWD Time Limit Medical Exemption Form (PDF 65.79 KB)

County Assistance Office List for ABAWD Exemption Forms (PDF 377.53 KB)

Able-Bodied Adults Without Dependents (ABAWD) Time Limit Brochure (PDF 1.4 MB)

Pennsylvania Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) Quick Reference Guide (PDF 298.52 KB)

Changes to NDC Claim Processing Requirements — Effective March 1, 2016  (PDF 33.98 KB)

 

Payment Policy Notifications

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

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

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)

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