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

UHC Exchange Plans: diabetes medications coverage.

This change applies to members that have Individual and Family (Exchange Plans)1 and are on diabetes medication.

As of September 1,2022 and thereafter UHC will no longer cover diabetes medications: Invokana® and Invokamet® 

Current Medication Coverage:

UHC will cover these medications for patients that are currently have an authorization, until Dec 31,2022.

New covered medications
Effective for DOS 09/01/2022 and thereafter, we’re covering diabetes medications Farxiga® and Xigduo® XR for Individual Exchange plans.²

Members also have access to alternative diabetes medications:

  • Farxiga
  • Xigduo XR
  • Jardiance®
  • Synjardy®

¹For these plans in Louisiana and Texas, we’ll no longer cover Invokana and Invokamet as of Jan. 1, 2023.
²For these plans in Louisiana and Texas, we’ll cover Farxiga and Xigduo XR as of Jan. 1, 2023.

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Posted in #unitedhealthcare, Training, Updates

UHC- no more physical payment checks 06/01/222

According to UHC as of 06/01/22 they will no longer issue physical checks to providers. In order for the providers to get paid they will have 2 options.

Option 1: By May 18/22- provider can enroll into ACH with Optum Pay. This should allow sufficient time for registration to be complete before UnitedHealthcare stops mailing paper checks. This is the quickest form of payment. We can route payments at the tax ID number (TIN) and National Provider Identifier (NPI) number level.

To enroll please complete your registration as soon as possible.

  • You’ll have automatic access to the Optum Pay free basic portal to review payment and remittance advice detail. (You can also view provider remittance advice (PRA) in Document Library at any time.) Learn about Document Libraryopen_in_new.
  • We cannot hold claim payments while you are registering for ACH/direct deposit. You’ll begin receiving claim payments through ACH/direct deposit once your registration is finalized and your ACH is activated with your financial institution.
    • If your ACH/direct deposit registration isn’t complete by June 1, you will receive virtual cards

Option 2: Virtual card payments: ( please take in consideration that this option does charge the provider a processing fee, like a credit card)

All health care professionals not enrolled and whose ACH/direct deposit registration hasn’t been finalized by June 1, 2022, will begin receiving claim payments in the form of virtual card payments (VCPs).1, 2 VCPs are electronic payments that use credit card technology to process claim payments. There is no requirement to share bank account information.

1. Merchant card processing fees may apply to virtual cards. Please reach out to your merchant processor or financial institution for information on specific terms and costs.

2. Processing your virtual card indicates your consent to receive and accept virtual card payments as payment in full from the payer.

Please note: Network health care professionals and facilities are required to do business with UHC electronically. We must have a valid email address on file to send you required notifications and important information. Please update your preferences regularly. More details are available in the Provider Communication chapter of the 2022 UnitedHealthcare administrative guide.

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UHC Commercial Plan: new prenatal ultrasound policy -2022

As of 06/01/2022- UHC announced a new prenatal ultrasound policy for the year 2022. The reimbursement for this policy will be determined post-service, with pre-pay based on the following:

  1. The first 3 prenatal ultrasounds are going to be covered and medical necessary: CPT® codes 76801, 76802, 76805, 76810, 76811, 76812, 76815, 76816 and 76817
  2. 4 or more ultrasounds will be considered proven and medically necessary for high-risk pregnancies, as described in the policy, when the treating provider will make therapeutic determinations based upon the results.

This policy applies towards professional services billed on HCFA1500 form and performed in POS 11 and 22.

This policy doesn’t apply to:

  • Prenatal ultrasounds rendered in an emergency room
  • Outpatient observation care
  • Inpatient hospital setting

Charging patients for NON-COVERED services:

Please note, you’ll need to get written consent prior to the service if you bill patients for services denied for lack of medical necessity. Patient consent will need an estimate of the charges and a statement of the reason you believe the service may not be covered. See the “Charging members for non-covered services” protocol in the UnitedHealthcare care provider administrative guide.”

Please click here to review the new  obstetrical ultrasound medical policy

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