Category: Training

Posted in #reimbursement, #unitedhealthcare, NY Providers, Training

NYS UHC Community Plan: which services require a referral?

Posted on by KR2Medical Billing

With the uncertainty increasing in the Healthcare industry it is imperative to keep yourself updated on which plans require referrals from PCPs to see a specialty.

UHC Community Plan members might not require referrals for all of their specialists but some still do:

  • Allergy and immunology
  • Dermatology
  • Endocrinology
  • Gastroenterology
  • General surgery
  • Neurological surgery
  • Orthopedic surgery
  • Otolaryngology
  • Physical medicine and rehabilitation/physiatry
  • Plastic surgery
  • Podiatry
  • Pulmonary medicine
  • Sports medicine
  • Urology
  • Vascular surgery

Please make sure that the PCP goes on the https://www.uhcprovider.com/ and uses the referral solution in the Provider Portal to create a referral in order to avoid any unnecessary denials.

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

Musculoskeletal surgical services prior auth change for FL UHC plans

Posted on by KR2Medical Billing

This authorization process change affects FL ASO and fully insured plan types.

Please note that after any DOS 5/1/2025, Turning Point Healthcare Solutions LLC will take over the authorization process for musculoskeletal surgical procedures.

Starting April 21st 2025 the providers should start to contact the TurningPoint to request an authorization.

Please contact Turning Point Healthcare via phone/fax: 904-895-4007/904-544-8025 or sign up on their portal: https://www.myturningpoint-healthcare.com/

This change does not apply to the following plan types:

Commercial plans of members who reside in the U.S. Virgin Islands
Optum Care®
Surest®
UMR™
UnitedHealthcare Individual Exchange plans (also referred to as UnitedHealthcare Individual & Family ACA Marketplace plans)
WellMed®

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