Category: #unitedhealthcare

Find medical billing and coding guidance for UHC Insurance Payer (Commercial, Medicaid and Multiple States)

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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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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