Category: #unitedhealthcare

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

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

Posted in #reimbursement, #unitedhealthcare, Payer Updates, Training, Updates

UHC Minnesota Community Plan: non-emergency transport

Posted on by KR2Medical Billing

Effective immediately, UHC is going to process claims and payment for all non-emergency transportation services for Community Health Plans of Minnesota.

The following HCPCS codes are affected:

HCPCS code A0428: Ambulance service, basic life support, non-emergency transport

HCPCS code A0130: Non-emergency transportation: wheelchair van

This change applies to the following plans:

  • UnitedHealthcare® Families and Children Medical Assistance (PMAP)
  • MinnesotaCare
  • Minnesota Senior Health Options (MSHO)
  • Minnesota Senior Care Plus (MSC+)
  • Special Needs Basic Care (SNBC) plans

Providers please submit your claims directly to the UHC  Community Plan instead of submitting them to MTM Inc.

Any previousely unpaid claims that were submitted to MTM Inc. on DOS 7/1/22 and thereafter can be resubmitted to UHC Community HealthPlan directly Oct 1,2024. Timely filling will be waived for these 2 particular codes.

Submitting claims:

Using UHC EDI or UHC portal.

For any further questions, providers can chat with UHC 7 a.m.–7 p.m. CT, Monday–Friday from the UnitedHealthcare Provider Portal.open_in_new For additional contact information, visit UHC Contact us page.

Find this type of content useful? Follow my blog for the latest news in healthcare. #medicalbilling #medicalcoding #reimbursement #UHC