Tag: #uhccommunityhealth

Posted in Training, Updates

Alert: UHC Community Health NY- allergy testing changes 05/01/2021

Posted on by KR2Medical Billing

As per UHC Community Health NY bulletin- the following changes will take place, effective 05/01/2021 for allergy testing codes:

The frequency (Medically Unlikely Units Policy) will reflect the policy enhancements over 5-year period, in accordance with NY State Policy Requirements.

**If you ever watched my BC Advantage presentation on Allergy Tests (2020) – please update your records. Note: I always state that you should check the policies discussed in all of my webinars/presentations at least 6 months after you watch them.

What does this mean for the provider?

If the provider will bill over the maximum allowed amount for each of above listed code, those “extra” units will be denied.

#allergytesting, #UHCcommunityhealth, #invitro, #intradermal, #penicilintesting

Posted in Insurance, Training, Updates

UHC NY Medicaid Plans: Physical Therapy and Occupational Therapy code changes

Posted on by KR2Medical Billing

This policy is retroactive as of 12/01/2020.

This policy change affects the following plans:

  • UnitedHealthcare Community Plan for Families (Medicaid)
  • UnitedHealthcare Community Plan Wellness 4 Me (HARP)

The non-covered codes section clarifies and supplements the UnitedHealthcare Community Plan of New York National Outpatient Physical and Occupational Therapy policy. All other CPT codes for physical and occupational therapy services will be considered non-covered.

Please still check the member benefit plan document that may supersede the additional considerations and coverage limitations and exclusions and prior authorization requirements.

Partial PT/OT covered list:

Partial Non-covered codes list:

For the complete list of covered and non-covered PT/OT codes, please click here.

Posted in Insurance, My services, Training, Updates

UHC Community Health (NY) Specialist Referral Requirements, 03/01/2021

Posted on by KR2Medical Billing

These Specialist Referral Requirements will apply to the following:

  • UnitedHealthcare Community Plan for Families (Medicaid)
  • UnitedHealthcare Community Plan Wellness 4 Me (HARP) 
  • UnitedHealthcare Community Plan ChildHealthPlus (CHP)

This new change will take effect on 03/01/2021. The referrals will need to be generated by the member’s PCP. Primary Care Providers can begin to request a referral for any date on 03/01/2021 and thereafter.

Between now and 03/01/2021, in network specialists will continue to get reimbursed as usual.

The following services that WILL NOT REQUIRE A REFERRAL:

  • Women´s Health Care
  • Family Planning 
  • HIV and STI Screening
  • Eye Care (subject to benefit limits in member handbook)
  • Dental Care
  • Behavioral Health – (Mental Health and Substance Use)
  • Smoking Cessation
  • Maternal Depression Screening
  • Services rendered in any emergency room or network urgent care center
  • Physician services for emergency/unscheduled admissions
  • Any services from inpatient consulting physicians
  • Radiologist, Pathologist, Anesthesia, etc. Providers that are part of inpatient hospital care or surgical teams do not need referrals
  • A specialist who has arranged to act as the member’s PCP does not need a referral for him or herself. Please see FAQs for additional information. Any other services for which applicable laws and regulations do not allow us to impose a referral requirement.

ANY services that are NOT LISTED above will REQUIRE a REFERRAL from the PCP to the IN-Network Specialist.

If you have any questions, please call: 888-362-3368. 

#UHC #referral #specialists #PCP #NYproviders #communityhealth #HARP #nymedicaid