Category: Payers and CPT reinbursement

Posted in MVP (NY/VT) Insurance Payer, NY Medicaid EHR incentive program, NY Providers, Payers and CPT reinbursement, Updates

MVP postpartum program incentive payments: NY providers!

Posted on by KR2Medical Billing

Are you any of these following providers in NY?

OB/GYN Family Medicine Certified Nurse Mid-wives Nurse Practitioner – Family Health

Then this blog post is for you!

NY DOH established an additional payment (to global OBGYN bundled payment) for providers that complete a person-centered postpartum visit— including a depression screening—within 12 weeks of delivery, as per ACOG/AAP guidelines.

In order to qualify for this additional payment the postpartum services need to be related to deliveries that occurred from July 1, 2024, through March 31, 2025.

Coding that qualify for this program are:CPT II Code 59430 or 0503F

Please bill these codes with $0

This program only applies to Managed Medicaid Care Plan type.

The additional payment amount is $125.

The payments are maid quaterly basis.

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Posted in #reimbursement, #unitedhealthcare, Payer Updates, Payers and CPT reinbursement, Prior Authorization Insurance Carrier Updates, Training

UHC Community Health Texas- new billing workflow

Posted on by KR2Medical Billing

Are you a provider offering services to UHC Community Health dual eligible special need members? Then this blog post is for you!

As per recently passed bill: Texas House Bill 1open_in_new (Art. II, HHSC, Rider 32); there are new medical billing workflow that is in affect for any DOS 9/1/2025 and thereafter.

The following services will no longer be covered by Texas Health and Human Services Commission (HHSC).

Instead the providers would need to bill for any Medicare wrap around service to UnitedHealthcare Community Plan of Texas directly.

For any wrap around covered medications, including OTC- OptumRx will manage those.

Medicaid-covered services will switch from FFS to managed care billing based on the HHSC rate

Services provided through FFS for Medicaid-only beneficiaries, like pediatric nursing facility services, will not be affected

Some services and service would need a prior authorization.

For this the provider would need to go to UHCprovider.com and select Sign In at the top-right corner

  • Sign in to the portal using your One Healthcare ID and password
  • In the menu, select Prior Authorizations
  • In the Prior Authorization and Notification tool, scroll down to “Create a new notification or prior authorization request” and click Create New Submissions
  • Enter the required information and submit

If you need to find the list of the procedures and codes that require an auth please click here:

Listopen_in_new window- PDF

View all of the Rider 32 0rocedure codes and descriptions here: listingopen_in_new window

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Posted in #reimbursement, #unitedhealthcare, NY Providers, Payers and CPT reinbursement, Training

NYS UHC Community Plan OBGYN required codes

Posted on by KR2Medical Billing

Are you an OBGYN that practices in NYS and accepts UHC Community Plan? Then this blog post is for you.

As per UHC Community Health Plan announcement the claims need to be submitted with the additional codes:

0500F – Initial prenatal visit
0502F – Subsequent prenatal visit
0503F – Postpartum visit 

These codes are not reimbursed separately and are only used for HEDIS reporting.

Please do not forget to bill the proper OBGYN codes (global, etc) in order to get reimbursement.

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