Tag: UnitedHealthcare (UHC)
UnitedHealthCare
Looking for UHC updates?
- Medical Policy Updates
- Reimbursement Policy Updates
- Looking to review all the updates?
See the monthly overview
Prior Auth. Time Frames
Several commercial payers have resumed prior authorization time frames and requirements that had been suspended because of the COVID-19 emergency, while others will continue to approve prior auth requests or suspend them for at least part of the year.
Below is an overview of some payers’ COVID-19 prior authorization policies as of April 2021: Click on the Links for more detail.
Blue Cross and Blue Shield of Texas ended approvals on services with existing prior authorizations on Dec. 31, 2020.
Aetna is approving prior authorization requests for commercial and Medicare Advantage members until the end of the plan year. “Authorization may be extended beyond the plan year, for a period of six months, if continued eligibility can be confirmed.”
Cigna resumed standard prior authorization time frames and requirements beginning April 1, 2021.
Humana resumed standard prior authorization time frames and requirements beginning April 1, 2021
UnitedHealthcare will not require prior authorization for most services through the national public health emergency period, currently scheduled to end April 20, 2021. Exceptions include medical and behavioral health services, post-acute care admissions, site of service reviews, and transfers to new providers. Prior authorizations for medical and behavioral health were not subject to extension on or after April 10, 2020.
Article written by Ellen Terry : https://www.texmed.org/TexasMedicineDetail.aspx?id=53502&utm_source=Informz&utm_medium=Email&utm_campaign=TMT&_zs=cPrdA1&_zl=CvCF6
UHC Cuts NPP Payments
A recent UnitedHealthcare (UHC) policy will not only cut payments by 15% to physicians who employ nonphysician providers (NPPs), but also cause needless confusion in the billing process.
That’s according to a letter the Texas Medical Association wrote to the insurer expressing concern over the policy, which took effect March 1.
UHC in December announced a policy that requires advanced practice nurses and physician assistants to bill for their services using their own National Provider Identifier (NPI) when they have not met “incident-to” billing requirements.
Payments billed using an NPP’s NPI number are typically 85% of the physician’s rate.
Despite medicine’s concerns, UHC further revised its policy in March to require that services provided by NPPs will be eligible for incident-to consideration – and thus the full 100% payment – only if the NPPs do not have their own NPI number.
That policy is scheduled to take effect May 1.
“It is TMA’s policy on physician assistants and allied health personnel that reimbursement for services performed by a physician assistant should be made directly to the responsible physician,” TMA wrote in a letter in February. “While greater use of nonphysician personnel can improve the system, responsibility for care must be clearly defined if various personnel are to work together effectively to provide high quality services for the patient.”
TMA also urged UHC to provide further education to physicians and NPPs on proper incident-to billing.
“As part of this effort, UHC should make it clear that physicians can continue to utilize advanced practice nurses and physician assistants under proper incident-to billing arrangements, even if the advanced practice nurse or physician assistant has their own NPI,” the letter says.
TMA is setting up a meeting with UHC officials to discuss the policy, and will report on any updates in Texas Medicine Today.
For more information on incident-to billing requirements, TMA has published a questions and answers document and billing guidelines.
Reimbursement Policy Update Bulletin: UHC March 2021
UHC releases revised reimbursement policies for: Outpatient Hospital, Laboratory Services and Emergency Department E/M.
Reload document 
Open in new tab Select CoVid-19 Temporary Cost Share Wavers are Extended. UHC Feb. 26, 2021
To continue to meet your needs through the evolving COVID-19 health emergency, UnitedHealthcare is extending select COVID-19 treatment cost share waivers, which are summarized below. We also continue to make ongoing updates to our COVID-19 billing and reimbursement guidance with the latest information, including giving providers a way to look up member Medicare ID numbers when submitting COVID-19 vaccine administration claims to the Centers for Medicare & Medicaid Services (CMS) Medicare Administrative Contractor (MAC).
Recent Comments