Billing Beat

UHC MA Plan

August 10, 2023

 

  • Effective with date of service September 1, 2023, UnitedHealthcare Medicare Advantage will align with the Centers for Medicare and Medicaid Services (CMS) requirement that a legally eligible ordering/referring provider be identified on all claims all claims billed by Clinical Laboratories, Imaging Centers, DME Suppliers and Home Health Agencies. Claims will be denied when the CMS Ordering/Referring Provider eligibility criteria are not met.
  • The new claim edits will determine if the Ordering/Referring Provider (when required to be identified in Part B

clinical laboratory and imaging, DME, and Part A HHA claims) (1) has a current Medicare enrollment record and

contains a valid NPI (the name and NPI must match), and (2) is of a provider type that is eligible to order or refer for Medicare beneficiaries

Source: https://www.uhcprovider.com/content/dam/provider/docs/public/policies/medadv-reimbursement/rpub/UHC-MEDADV-RPUB-AUG-2023.pdf

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