Tag: UnitedHealthcare (UHC)
UHC Updates October 2022
Policy and protocol notice
Get the latest updates, legal mandates, state-specific news, trainings and more for
Medicare Advantage, Medicaid and Individual and Group Market plans.
UHC Network News August 2022
New Smart Edit for Commercial Plans
Effective Aug. 25, 2022, a new Smart Edit will be available for commercial plans to help with coordination of benefits when you submit a claim.
How the new Smart Edit works
When you submit a claim for a member who has a commercial plan and primary health insurance with another carrier, you’ll receive 1 of the following 3 messages on your 277 Claims Acknowledgement report within 24 hours of submission:
- REJECT – This patient has primary insurance coverage with <other insurance name>, <effective Date>. Please resubmit as electronic secondary once adjudicated by the primary payor.
a. You’ll receive this message if we have the primary health insurer’s name and effective date, but don’t have the other carrier’s EOB. - REJECT – This patient has primary insurance coverage with another carrier with <effective date>. Please resubmit as electronic secondary once adjudicated by the primary payor.
a. You’ll receive this message if we have the effective date, but don’t have the other carrier’s name or EOB. - REJECT – This patient has primary insurance coverage with another carrier. Please resubmit as electronic secondary once adjudicated by the primary payor.
a. You’ll receive this message if we’re missing the carrier’s name, effective date and EOB.
What is the Smart Edits tool?
We developed the Smart Edits tool to identify billing errors within a claim so you can quickly review and repair problematic claims. We send these messages within 24 hours of a claim submission so you can review identified claims in a matter of hours instead of potential claims denials days later.
Claims that are accurately submitted and in compliance with the latest policies and regulations result in less rework, quicker approvals and faster payments.
Learn more
- For information on how to submit the primary payer EOB online, visit UHCprovider.com/ediclaimtips > Secondary/COB or Tertiary Claims and Medicare Crossover > COB Electronic Claim Requirements – Commercial
- Visit UHCprovider.com/smartedits to:
- See the list of all available Smart Edits by selecting Smart Edits Guide
- Take a self-paced training by selecting Smart Edits interactive guides
Questions?
- For information about Smart Edits claims, please contact your electronic data interchange (EDI) vendor or clearinghouse
- For additional help from us, visit our EDI Contacts page on UHCprovider.com
UHC Policy and Protocol Updates
UHC Network News
Do you and your staff have the UHC Prior Auth Blues?
UHC June Policy and Protocol Updates
Check out these links to UHC Policy Updates:
UHC User Friendly Self Service Resource Guide.
Feel Free to Print and Keep at Your Desk.
UHC Prior Auth Going Paperless
UHC won’t be sending prior authorization and clinical decision letters by mail starting April 1.
This includes:
- Pre-service/prior authorization decision letters
- Inpatient review letters, including concurrent, retrospective, length of stay and level of care
- Extension for lack of clinical information letters
- Complex care management and OrthoNet letters available in Document Library
Instead, you can view them exclusively online 24/7 through either the UnitedHealthcare Provider Portal or an Application Programming Interface (API) system-to-system data feed.
UHC Policy Updates for March 2022
Just click the button to check out the latest from UHC.
CoVid-19 News from UHC
Beginning Jan. 15, 2022, UnitedHealthcare is covering the cost of Food and Drug Administration (FDA)-authorized or approved over-the-counter (OTC) at-home COVID-19 diagnostic tests for Individual and Family Plan and Individual and Group Market health plan members.
- The national public health emergency has been extended from Jan. 15, 2022 to April 15, 2022. See how that extension affects temporary provisions for COVID-19 testing and testing-related visits:
- Currently there are 2 monoclonal antibody and 3 antiviral treatment options authorized or approved for use.
- Reminder: CMS Billing change effective 1/1/2022.
- Health care professionals who administer the COVID-19 vaccine serum or monoclonal antibody treatment to Medicare Advantage members should submit medical claims through the UnitedHealthcare standard claims process.
- For services rendered through Dec. 31, 2021, claims should be billed to the applicable Centers for Medicare & Medicaid Services (CMS) Medicare Administrative Contractor (MAC), as previously established for reimbursement of these claims
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