Laboratory Rebundling Policy - changes relating to surgical pathology consultation codes reported with evaluation and manage
Friday, May 27, 2011
The policies will be revised to better align with CMS and the AMA correct coding guidelines. Duplicate laboratory codes reported with modifiers 76 or 77 will no longer be reimbursed. This aligns with CMS' policy which denies laboratory services when reported with either modifier 76 or 77, citing that other modifiers (e.g., modifiers 59 or 91) are more appropriate.
Friday, May 27, 2011
The purpose of the Maximum Frequency Per Day policy is to ensure that UnitedHealthcare reimburses physicians and other health care professionals for the units reported without reimbursing for obvious billing submission and data entry errors. To do this, UnitedHealthcare has established maximum frequency per day (MFD) values, which are the highest number of units eligible for reimbursement of services on a single date of service.
Friday, May 27, 2011
UHC has announced the following changes regarding KRAS Pathology Requirement submissions to obtain coverage for Erbitux® (cetuximab) and Vectibix® (panitumumab):
• UnitedHealthcare has removed the requirement to submit a pathology report. This change occurred with our system update and was effective for claims submitted after Feb. 21, 2011
• Oxford Health Plan has eliminated the requirement for a pathology report submission for claims submitted after April 1, 2011
Tuesday, March 29, 2011
Effective with claims submitted with a date of service on or after June 1, 2011, UnitedHealthcare will adopt the changes in the CMS 2011 multiple imaging reduction payment policy. With this revision, UnitedHealthcare will align with the CMS's multiple imaging payment methodology and treat the services as if they were from a single diagnostic imaging family. The 50 percent imaging reduction will be applied to the allowable amount for the technical component of multiple imaging procedures reported in the same patient session that are considered second and/or subsequent.
Tuesday, March 29, 2011
The Policy will be revised, implementing mutually exclusive edits that are not presently administered in other UnitedHealthcare reimbursement policies. Mutually exclusive edits are code pairs that should not be reported together for a number of reasons explained in the CMS National Correct Initiative Coding Policy Manual for Medicare services. Following CMS methodology, UnitedHealthcare will reimburse for the code with the lower RVU value.
Tuesday, March 29, 2011
The new UnitedHealthcare Physician, Health Care Professional, Facility and Ancillary Provider 2011 Administrative Guide is effective April 1, 2011 for currently participating physicians, health care professionals, facilities and ancillary providers. For those newly participating on or after Jan. 1, 2011 (except in North Carolina), the Guide is effective immediately.
Monday, January 31, 2011
Effective Jan.1, 2011, UnitedHealthcare made changes to the procedure code list for the Radiology Notification and Prior Authorization Programs. Claims with dates of service on or after Jan. 1, 2011 are subject to these changes. Please refer to the January Network Bulletin article for further details.
Monday, December 20, 2010
We've begun implementing a slight change in our card standard for our medical and prescription drug cards. These cards will include prescription information (Rx Bin, PCN and Group) that is typically displayed on the front of the cards to also be electronically encrypted in the bar code on the back of the card. This is a new feature available by using bar codes that was not previously included on the magnetic stripe.
Tuesday, October 26, 2010
United Healthcare and its affiliates announced the new medical policy for Proton Beam Radiation Therapy (PBT) earlier this year.
Tuesday, October 26, 2010
Electronic Payments and Statements (EPS) as accessed through UnitedHealthcareOnline.com was recently enhanced to provide additional claim information and improved navigation of claim and remittance documents. Rendering Provider, Group Policy Number and Product Name information now displays when available. In addition, page displays have been redesigned for easier document viewing.
Friday, June 25, 2010
On April 16, 2010, the Settlement Claims Administrator began mailing the Settlement Notice, claim form and claim form instructions for the UnitedHealth Group UCR settlement to physicians. Physicians will be receiving a plain white mailer with “United Healthcare” written on the bottom and with the return address referencing the Settlement Claims Administrator: United HealthCare Class Action Litigation c/o Berdon Claims Administration LLC, P.O. Box 15000, Jericho, NY 11853-1001. The mailer includes the Settlement Notice, claim form and claim form instructions.
Friday, June 25, 2010
UHC will expand the scope of its radiology protocols to include Medicare Advantage Plans offered by SecureHorizons®, Evercare® and AARP® Medicare Complete®. Effective June 7, 2010, UHC will require all participating physicians who are subject to the UnitedHealthcare Administrative Guide to contact them to obtain prior authorization when ordering select advanced imaging procedures for Medicare Advantage members and subject to UnitedHealthcare Provider Administrative Guide.
Friday, June 25, 2010
For claims with dates of service September 7, 2010 and thereafter, UHC requires rendering providers to submit notification for services ordered by non-participating physicians when no notification is on file, in accordance with the Radiology Notification protocol for commercial benefit plans set forth in the UnitedHealthcare Physician, Health Care Professional, Facility and Ancillary Provider Administrative Guide.
Friday, June 25, 2010
The following enhancements apply to UnitedHealthcare Government and other lines of business. You may begin to see these changes starting with 835s and payments received from UnitedHealthcare after June 19, 2010.
National Provider Identifier
UHC will implement the following changes for Government and other lines of business which will improve the consistency between the National Provider Identifier (NPI) received on a claim and the NPI returned on the 835I:
Friday, June 25, 2010
As a result of provider feedback, UnitedHealthcare will implement a system enhancement that will consolidate more commercial claims into one payment and will improve the layout of the Provider Remittance Advice (PRA). This enhancement impacts all claims associated with UnitedHealthcare commercial fully-insured and commercial self-funded business. This affects both 835s and paper versions. Implementation will begin later in 2010. We will notify providers and clearinghouses prior to deployment.
Friday, June 25, 2010
UHC successfully deployed enhancements to its 835/Electronic Remittance Advice (ERA) on March 20, 2010. The enhancements apply to UnitedHealthcare Government and other lines of business and focused on changes to the reporting of Member Identification Numbers on 835s.
Monday, May 03, 2010
The American Medical Association (AMA) today launched a new online resource that will help thousands of physicians file claims in the record-breaking settlement reached in the AMA legal victory against UnitedHealth Group—the nation’s largest health insurer. More than $350 million is available to compensate physicians and their patients for 15 years of artificially low payments for out-of-network services.
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