Category: Prior Authorization Insurance Carrier Updates

Posted in #reimbursement, #unitedhealthcare, Prior Authorization Insurance Carrier Updates

UHC Community Health Plan LTSS of DC: DME prior requirenments

Posted on by KR2Medical Billing

For some specific DME equipment, prior auth requirenments will align with durable medical equipment (DME) prior authorization requirements of the UnitedHealthcare® Dual Complete® Special Needs Plan (DSNP).

These requirenments take effect on 10/1/25 and apply to members with UnitedHealthcare Community Plan District of Columbia as well as integrated DSNP plans for Long-Term Care Services and Supports (LTSS).

Some of these DMEs are:

Patient lifts
Power wheelchairs
Respiratory support devices

Among others.

These prior authorization requirenments apply to the following codes:

To request an auth:

Phone: Call 888-702-2202

Fax: 866-968-7582. The fax form is available at Prior Authorization Forms on UHC website.

Or request the auth on the portal:

Sign in to the UnitedHealthcare Provider Portalopen_in_new with your One Healthcare ID

If you don’t have a One Healthcare ID, register now

From the left-hand tabs, select Prior Authorizations & Notifications

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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 #unitedhealthcare, Payer Updates, Prior Authorization Insurance Carrier Updates, Training

UHC Colorado: Rocky Mountain Health Plan-BH prior auth updates

Posted on by KR2Medical Billing

If you are a provider that accepts the following Rocky Mountain Health Plan types, then this blog post is for you:

  1. D-SNP: dual eligible special needs plan
  2. Child Health Plus
  3. Medicare Advantage
  4. Individual and Family plans
  5. Medicaid: RAE/PRIME

The following update will take affect for any DOS 7/1/25 and thereafter:

1.HCPCs – H2033, T2022- Multisystemic Therapy (MST), Enhanced MST: Requires pre-service notification, authorization necessary for services provided more than 90 days

2.H0036, T2022-Functional Family Therapy (FFT), Enhanced FFT: Requires pre-service notification, authorization necessary for services provided more than 90 days

3. G0137, H0015, Rev code 906- Substance use disorder intensive outpatient programming (SUD IOP): Requires pre-service notification, authorization necessary for services greater than 15 sessions

4. HCPCs code S9480, Rev code 905-Behavioral health intensive outpatient programming (BH IOP): Requires pre-service notification, authorization necessary for services greater than 15 sessions

5. Rev. code 0911-Psychiatric Residential Treatment Facility (PRTF): Requires prior authorization

6.H0019-Psychiatric Residential Treatment Facility (PRTF): Requires prior authorization

8. CPT codes: 6132, 96133, 96136, 96137, 96138, 96139, 96146, 96130, 96131-Neuropsychological and psychological testing (and related codes): Requires prior authorization

7. H0017- All services associated with H0017, including Acute Treatment Unit (ATU): Requires prior authorization

9. CPT codes- 96116, 96121- Neurobehavioral status exam: Requires prior authorization

To access the full list of codes, please click here: https://www.uhcprovider.com/en/prior-auth-advance-notification/adv-notification-plan-reqs.html and find the BH section

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