Posted in #unitedhealthcare, Training, Updates

UHC: Maryland Medicaid Members – Doula services are now COVERED!

As per UHC- UHC Community Plan Maryland (Medicaid) Members will now have doula services covered through the plan.

What services can a doula offer?

  • Doulas offer continuous physical, emotional and informational support to the birthing parent throughout the perinatal period
  • Doulas offer person-centered care that supports the racial, ethnic and cultural diversity of members while adhering to evidence-based best practices
  • Doulas are non-clinical providers and cannot replace a trained, licensed medical professional or carry out clinical tasks

Doula Benefits:

  • 8 prenatal or postpartum services up to 60 minutes each
  • Attendance during labor and delivery

I am a Doula, what do I need to do in order to get reimbursed by the UHC?

  • Doulas must enroll with Maryland Medicaid before obtaining an agreement with UnitedHealthcare Community Plan
  • Doulas will be asked to attest to training and certification by an organization approved by the Maryland Department of Health

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Posted in #unitedhealthcare, Training, Updates

UHC Community Health Plan: Maryland Medicaid PT/ST/OT prior auth req

This blog refers to physical therapy, occupational therapy, and speech therapy that is done by Maryland Providers for Maryland Medicaid members that are 21 years and older.

As of May 1, 2022, all Maryland Medicaid (UHC community health plan) members will require a prior authorization in order to receive physical therapy, occupational therapy and/or speech therapy.

Important things to remember:

These requirements will apply whether a member is new to therapy or will continue receiving therapy

Prior authorization isn’t required for emergency or urgent services!

UHC community health plan (Maryland) will deny claims if prior authorization is not on file before the date of service, and you won’t be able to balance bill the member!

Medical necessity review
When the provider submits a prior authorization request starting May 1, 2022, UHC Community health plan (Maryland) will review your request for medical necessity. We will provide an authorization, if appropriate and send that determination to you and the member.

To help ensure members that are currently under your care do not experience disruption of services, providers may initiate a continuity of care request. UHC Community Health plan of Maryland will allow an approval for the current episode of care or 90 days, whichever is less, to continue upon receipt of the request and completed plan of care.

For the full list of therapy codes, reference the list of current prior authorization plan requirements for Maryland Medicaid.

Providers can submit requests for these services with dates of service on or after May 1, 2022, online using the Prior Authorization and Notification tool. Providers must submit a completed plan of care to prevent any disruption in services.

If you have any questions: please call 877-842-3210.

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Posted in Training, Updates

HEDIS Measure: Well-child visits in first 30 months.

Bringing young children to see the primary care physician, for a well-care visit is extremely important.

These visits track:

Prevention: wellness visits ensure children receive scheduled immunizations that prevent illness. It is also a great opportunity to discuss nutrition and safety in the home.

Growth and development. Evaluating children for growth and development enables parents to see how much their children have grown since the last visit. It is also an opportunity to share the children’s development, to discuss milestones, social behaviors, and learning.

Raising concerns. Offering parents an opportunity to share concerns at the start of the visit will help in your evaluation of the patient. They may want to talk about development, sleep and eating habits and behaviors.

Team approach. Regular visits create strong, trustworthy relationships among physician, parent, and child. The American Academy of Pediatrics (AAP) supports well-child visits as a way for pediatricians and parents to serve the needs of children. This team approach helps develop optimal physical, mental, and social health of a child.

Description of the measure:

Describes the percentage of members who had to the following number of well-child visits with a PCP during the last 15 months.

The rates are reported as follows:

Well-child visits in the first 15 months: Six or more well-child visits with children who turned age 15 months during the measurement year.

Well-child visits for ages 15 to 30 months: Two or more well-child visits with children who turned age 30 months during the measurement year.

In order to receive credit for this measure the following DX should be used:

  • ICD-10:110, Z00.111, Z00.121, Z00.129, Z00.2, Z00.3, Z02.5, Z76.1, Z76.2

The following CPT codes should be used:

  • CPT: 99381-99382, 99391-99392, 99461

The following HCPCS should be used:

  • HCPCS: G0438-G0439, S0302

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