This policy will be applied to UHC commercial Facility claims, starting for DOS 09/01/2021 and thereafter.
The following guidelines will apply:
1.The same day readmissions with same or related condition are required to be combined and reported on the same institutional claim (UB04-claim form or electronic equivalent) to be eligible for reimbursement
2. Same day readmissions with unrelated condition are required to be reported with condition code B4 on the institutional claim in order to be eligible for reimbursement
3. Planned readmissions or leave of absences, are required to be combined and reported on the same institutional claim with occurrence code 74 to report the dates the leave began and ended.
Exceptions to this policy:
- Admissions for chemotherapy or immunotherapy treatment
- Admissions for substance abuse unit or facility
- Admonitions to an inpatient rehab unit
- Readmissions after a patient is discharged from hospital against medical advice
- MVP (NY/VT)- Reimbursement sick visit and Preventative Care on the same day.
- MVP Health Plans: reimbursement of sick E&M codes billed w/preventative codes -05/01/23
- Michigan Medicaid: reimburses for Doula Services-01/01/23
- UHC NY Community Plan Referral requirement change-effective immediately
- UHC Oxford- updated Prior Auth changes 01/01/2023