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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Posted in #unitedhealthcare, Training, Updates

UHC Providers: Genetic testing Penalty waiver has expired!

This blog post applies to genetic/molecular testing penalty waiver, that was available to providers/labs while UHC was transitioning to a new Prior Authorization and notification Platform, in 2021.

This process finished and as of Jan 1,2022 the waiver has expired!

In order to get paid for genetic/molecular testing, providers must request a prior authorization and/or an advanced notification, for any code that requires it.

Where to request prior auth/advanced notification?

Providers must go to  Prior Authorization and Notification platform or by call 877-303-7736.

Performing laboratories can submit advance notifications.

If a test requires prior authorization with clinical criteria, the request must be submitted by the ordering provider.

For the current list of genetic and molecular tests that require prior authorization/advance notification, please go to > Advance Notification and Plan Requirement Resources.

For more information about the genetic and molecular lab testing prior authorization/advance notification program, please visit the UnitedHealthcare genetic and molecular testing prior authorization/advance notification (PAAN) web page and review the genetic and molecular lab testing PAAN FAQs.

Prior authorization/advance notification training
UnitedHealthcare is offering live training sessions for the genetic and molecular testing prior authorization/advance notification (PAAN) program. To register for training, please visit the UnitedHealthcare genetic and molecular testing prior authorization/advance notification (PAAN) web page.

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