Category: #unitedhealthcare

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

Posted in #unitedhealthcare, NY Providers, Payer Updates, Updates

UHC: Empire Plan- new cards

Posted on by KR2Medical Billing

As per UHC – members that have Empire NYSHIP plan and/or Student Employee Health Plan will have their cards updated for 2025.

Below please find the new design of the cards.

Source via UHC website
Source: via UHC website
Source via UHC website

So what do you think? Are they better than the old blue cards?

Find this information useful? Follow my blog for payer updates, medical billing and coding guidelines.

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

UHC: Empire Plan updates

Posted on by KR2Medical Billing

If you are a provider that accepts UHC Empire Plan in NY or a patient that has Empire plan then there are several important things that you should take notice of.

  1. Out of network allowed amounts: according to UHC- the reimbursement for OON providers is based on Medicare rates.
  2. Out of network acupuncture services: no matter how many providers that the member visits the maximum # of allowed visits is 20 per calendar year
  3. In network massage therapy services: only 20 visits are covered, per calendar year.
  4. Empire Plan mental health program that is administered by the Carelon Behavioral Health partnered with Hazelden Betty Ford Foundation to provide substance abuse services to the Empire plan members at no cost. Outpatient services are available in California, Florida, Illinois, Minnesota, New York, Oregon and Washington. Prior authorization is required.

If you find this type of information useful? Follow my blog for more up to date medical billing, coding, reimbursement and healthcare trends.

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

UHC Knee/Hip Surgery documentation requirenments.

Posted on by KR2Medical Billing

Effective for services performed on Nov 1,2024 and there after, there will be new requirements for the prior authorization documentation applied to the Knee/Hip surgeries.

These changes/updates apply to self insured and fully insured plans nationwide.

Codes affected:

27445,27447, 27130 and 27132 

Knee Surgery Documentstion requirenments:

  1. Complete diagnostic imaging Reports: -Documented closure of skeletal plates (age less than 18 years)
    -Presence or absence of focal full-thickness articular cartilage defect
    -Size and location of focal cartilage defect
    -Outerbridge grade
    -Joint space and alignment
    -Ligament tear location and grade
  2. Diagnostic Images: – show the abnormality- MRI, Xray, Bone scan.
  3. Prior treatment documentation (prior year): -NSAIDs or acetaminophen ≥ 3 weeks*
    -PT or home exercise ≥ 12 weeks
    -Activity modification ≥ 12 weeks

*For TJR Knee ≥ 1 intra-articular corticosteroid injection may be used in place of NSAIDs.

For more information please click visit: https://www.uhcprovider.com/en/resource-library/news/2024/documentation-requirement-updates-total-joint-replacements.html

Find this content helpful? Follow my blog for most recent updates in healthcare.

#medicalpolicies, #reimbursement, #medicalcoding, #medicalbilling