Tagged with UHC UnitedHealthcare
Effective May 1, UnitedHealthcare (UHC) will deny any non-patient lab test claims submitted by hospital outreach labs if billed under the hospital’s facility participation agreement. The insurer is requiring that hospital outreach labs are credentialed and contracted as an independent reference lab in order to get their non-patient lab test claims paid.
UnitedHealthcare has announced plans to implement certain changes to enhance the Procedure to Modifier Policy for Medicare Advantage plans to include modifiers CT, FX and FY.
UnitedHealthcare (UHC) has announced that starting April 1, 2020, they will use a proprietary software program to evaluate all professional claims submitted for emergency department visits with the Level 5 evaluation and management (E/M) code 99285.
Effective January 1, UnitedHealthcare (UHC) will update the procedure code list for the Radiology Notification and Prior Authorization programs based on code changes made by the American Medical Association (AMA). Claims with dates of service on or after January 1 are subject to these changes.
UnitedHealthcare (UHC) has released its 2020 Summary of Changes to Advance Notification and Prior Authorization Requirements.
UnitedHealthcare Expands Prior Auth Requirements and Site-of-Service Medical Necessity Reviews for Certain Surgeries
UnitedHealthcare has expanded prior authorization requirements and site of service medical necessity reviews for certain surgeries in an effort to shift surgical procedures to less expensive locations.
Effective October 1, 2019, Optum will make changes to and start managing prior authorization requests and processes for certain medical benefit injectable medications for UnitedHealthcare (UHC) commercial plan members.
Effective October 1, an affiliate company of UnitedHealthcare (UHC), will begin managing the insurer’s prior authorization requests for outpatient injectable chemotherapy and related cancer therapies for (UHC) Community Plan members in New Jersey.
UnitedHealthcare (UHC) Washington has released a notice detailing which procedure codes will require prior authorization for UnitedHealthcare Community Plan of Washington, effective for dates of service on or after October 1.
Effective September 1, UnitedHealthcare (UHC) will add a new policy for molecular pathology and will make changes to its procedure to modifier policy.
On May 21, UnitedHealthcare (UHC) discovered a claim edit was incorrectly loaded into its system. UHC is working to correct the error involving UHC Community Plan claims that included “Always Therapy” codes with and without the GN, GO or GP modifiers were denied for claims submitted on or after May 19, 2019.
Effective June 1, more network care providers will be required to obtain consent from UnitedHealthcare or UnitedHealthcare Oxford members before referring them to or using out-of-network laboratories and pathologists for their care.
UnitedHealthcare has released changes to its coordinated commercial reimbursement policy, which includes updates to its procedure to modifier policy and consultation services policy.
New Jersey, Pennsylvania, Rhode Island – UHC Genetic and Molecular Lab Testing Notification Requirement
UnitedHealthcare will soon require providers in New Jersey, Rhode Island, and Pennsylvania to complete the notification/prior authorization process for genetic and molecular testing performed in an outpatient setting.
UHC has posted a correction to authorization previously published code additions, as well as new codes requiring prior authorization.
In 2019, UnitedHealthcare (UHC) will be growing its national network of participating laboratory providers to better support members and the care providers who order laboratory services.
UnitedHealthcare (UHC) has released its most recent medical policy updates for November 2018 which includes complete details on UHC medical policy, medical benefit drug policy, coverage determination guideline), utilization review guideline, and/or quality of care guideline updates, as well as new, updated, revised, replaced and retired health services policies.
In November, UnitedHealthcare (UHC) will make changes to the way it manages prior authorization requests for certain outpatient injectable cancer therapy, including chemotherapy and biologic therapy, colony stimulating factors and denosumab.
Effective April 1, UnitedHealthcare (UHC) will require care providers to submit a notification for injectable chemotherapy for members located in Wisconsin when it is administrated in an outpatient setting for UHC Medicare Advantage (MA) members with a cancer diagnosis.
Connecticut, New Jersey, New York – Specialty Pharmacy Requirements for Certain Specialty Medications
UnitedHealthcare (UHC) will soon require Oxford Health Plan Commercial Members, participating hospitals in New York, New Jersey and Connecticut to purchase certain medications from a specialty pharmacy.