Tag: #uhcexchangeplans

Posted in #unitedhealthcare, Training, Updates

UHC Exchange Plans: no ref needed for chiropractic services

Posted on by KR2Medical Billing

According to UHC latest announcement for their exchange plans: patients that have individual or family UHC exchange plans will NO LONGER need a referral for chiropractor.

If you are provider in any following states, then this change will take affect for DOS 09/01/2021 and thereafter:

  • Arizona
  • Maryland
  • North Carolina
  • Oklahoma
  • Tennessee
  • Virginia
  • Washington State

Starting Jan 1, 2022, this change will also apply to new 2022 Individual and Family Exchange plans in these states:

  • Alabama
  • Florida
  • Georgia
  • Illinois
  • Louisiana
  • Michigan
  • Texas

If you are a provider and have a question regarding this change, please contact your provider relations advocate.

Find this content useful? Follow my blog for more Payer updates, medical coding and medical billing guideline changes, reimbursement and medical policy updates.

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Posted in #unitedhealthcare, Updates

UHC: OBGYN-New Elective Delivery Requirements 07/1/2021

Posted on by KR2Medical Billing

Starting 07/1/2021 UHC will require a delivery scheduling form documenting the clinical reason for early delivery form, for any DOS on or after 07/01/2021.

If providers do not have a form, please click here for UnitedHealthcare Delivery Scheduling Form, download and print the form.

Website address: https://www.uhcprovider.com/content/dam/provider/docs/public/policies/protocols/UnitedHealthcare-Delivery-Scheduling-Form.pdf

The form needs to be filled out for all births planned between 37 and 39 weeks of gestational age by participating physicians, or their designee.

In order to comply with the requirements the physicians or their designee must also:

  • Retain a copy of the delivery scheduling form in the mother’s medical record
  • Provide a copy to UnitedHealthcare upon request, within 15 days of request

Failure to comply with these requirements may result in appropriate action under your participation agreement which may include, but is not limited to, ineligibility for performance-based compensation or termination of your participation agreement.

Reminder: The American College of Obstetricians and Gynecologists (ACOG) guidelines, recommend non-medically indicated early term deliveries (prior to 39 weeks) be avoided.

If you would like to learn more about current medical billing and coding guidelines or reimbursement policies, check out my most recent posts:

Thank you for listening, and see you in the next episode!

Posted in Insurance, Training, Updates

UHC-Exchange Plans Prior auth change for non-emergent ambulance services in several States…

Posted on by KR2Medical Billing

As of 02/01/2021 Exchange Plans in the following states: Arizona, Maryland, North Carolina, Oklahoma, Tennessee, Virginia and Washington will require an authorization for non-emergent ambulance services.

Codes affected:

A0430, A0435 and S9960

Submitting Prior authorization:

The provider has to request an authorization ELECTRONICALLY. Non electronic prior auth request will NOT be processed.

If you need help in wit an online UHC tool please visit self-paced overview and training course. For more info visit UHCprovider.com/paan.

To access Exchange plans descriptions please select your state and clink on the link below:

Arizona UHC Exchange Plans- click here for information

Maryland UHC Exchange Plans- click here for information

North Carolina Exchange Plans- click here for information

Oklahoma Exchange Plans- click here for information

Tennessee Exchange Plans- click here for information

Virginia Exchange Plans- click here for information

Washington Exchange Plans- click here for information