Tag: #CommunityHealth

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 #unitedhealthcare, Training, Updates

UHC: Genetic testing for hereditary cancer-11 codes that are not covered

Posted on by KR2Medical Billing

Ordering Genetic Testing for your patients? Avoid the costly and unnecessary denials with the most up to date medical coding and medical billing guideline information. Below please find the updated information regarding UHC Genetic testing for hereditary cancer information.

There are 11 codes that were added to the list of non-covered, experimental/investigational list.

These codes will be denied, no matter the prior authorization status, as the Genetic Testing for Hereditary Cancer medical policy states, “genetic testing for BRCA1 and BRCA2 or Multi-Gene hereditary panels with RNA testing is unproven.”

The changes are applied to both Commercial and Medicaid Plans.

UHC Commercial Medical Policy. To visit the full policy please click here.
UHC Community Health (Medicaid)Medical Policy. For the full medical policy, please click here.

Partial List of non covered codes:

For the full list of noncovered codes please click here.

This change does not affect other BRCA1 testing, BRCA2 testing or multi-gene hereditary cancer panels, which will continue to require prior authorization.

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