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The U.S. Department of Health and Human Services has extended the COVID-19 national public health emergency by another 90 days. It was scheduled to end July 19, 2021 and now is scheduled through Oct. 17, 2021. The Summary of COVID-19 Temporary Program Provisions,

Actived: 8 days ago

URL: https://www.uhcprovider.com/

UnitedHealthcare Provider Portal UHCprovider.com

(4 days ago) Information and resources for our online self-service tools on the UnitedHealthcare provider portal. On the portal you can get member eligibility, benefits, claims and referral information for multiple UnitedHealthcare plans, all in one location.

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Home Health Care

(8 days ago) Home health services beyond benefit limits (e.g., number of visits) We will determine if benefits are available by reviewing both the skilled nature of the service and the need for Physiciandirected - medical management. A service will not be determined to be "skilled" …

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Optum ID name changing to One Healthcare ID UHCprovider.com

(4 days ago) Optum ID name changing to One Healthcare ID. Last modified: April 12, 2021. On the evening of April 9, 2021, Optum ID was re-named One Healthcare ID as part of our digital initiatives, technology updates and migration of UnitedHealthcare services to a new cloud platform. What this change means for you.

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Designated Diagnostic Provider UHCprovider.com

(1 days ago) UnitedHealthcare is launching a new benefit design for outpatient diagnostic lab services to help drive patient transparency and manage the cost of healthcare. Outpatient diagnostic lab services will be covered for commercial members at the lowest cost shared when delivered by a …

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Smart Edits UHCprovider.com

(8 days ago) Smart Edits is a claims optimization tool that identifies potential billing errors within a claim and allows care providers the opportunity to review and repair before the claim is processed. Smart Edits are sent 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.

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Neurophysiologic Testing and Monitoring

(6 days ago) Listing of a code in this policy does not imply that the service descrbi ed by the code is a covered or non -covered health service. Benefit coverage for health services is determine d by the member specific benefit plan document and applicable laws that may require coverage for a specific service.

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Cell-Free Fetal DNA Testing

(9 days ago) Benefit coverage for health services is determined by the member specific benefit plan document and applicable laws that may require coverage for a specific service. The documentation requirements outnli ed below are used to assess whether the member meets the clinci al criteria for coverage but do not guarantee coverage of the service requested.

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Ablative Treatment for Spinal Pain

(2 days ago) Benefit coverage for health services is determined by the member specific benefit plan document and applicable laws that may require coverage for a specific service. The documentation requirements outnli ed below are used to assess whether the member meets the clinci al criteria for co verage but do not guarantee coverage of the service requested.

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Skin and Soft Tissue Substitutes

(Just Now) Benefit coverage for health services is determined by the member specific benefit plan document and applicable laws that may require coverage for a specific service. The documentation requirements outnli ed below are used to assess whether the member meets the clinci al criteria for coverage but do not guarantee coverage of the service request ed.

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Home Health Care

(2 days ago) Non-health-related services such as help with daily living activities. Examples include eating, dressing, bathing, transferring and ambulating. Health-related services that can safely and effectively be performed by trained non-medical personnel and are provided for

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Durable Medical Equipment (DME), Prosthetics, Corrective

(5 days ago) Not Covered . EOC Exclusion ; Environmental control, not primarily medical in nature : Air -fluidized Bed (Bead), e.g., Clinitron . DME : Home use of an air-fluidized bed is recommended when all of the following criteria are met:

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01/2021: Shared Services Updates for GEHA UHCprovider.com

(5 days ago) Beginning Jan. 1, 2021, the following Government Employees Health Association (GEHA) members in the following states will now access the Choice Plus network of providers: Washington, D.C. GEHA members with the Choice Plus network will: GEHA members with the Options PPO network will use Conifer Health Solutions for inpatient medical and mental

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Electrical Stimulation for the Treatment of Pain and

(1 days ago) Benefit coverage for health services is determined by the member specific benefit plan document and applicable laws that may require coverage for a specific service. The documentation requirements outnli ed below are used to assess whether the member meets the clinci al criteria for coverage but do not guarantee coverage of the service requested.

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2021 UnitedHealthcare Care Provider Administrative Guide

(Just Now) workers’ compensation or other government programs. “Commercial” also applies to benefit plans for the Health Insurance Marketplace, government employees or students at public universities. • “You,” “your” or “provider” refers to any health care provider subject to this guide. This includes physicians, health

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2021 hospital policy changes: Notification updates for

(Just Now) This change impacts UnitedHealthcare Medicare Advantage and UnitedHealthcare commercial health plans at this time. UnitedHealthcare Exchange plans, Dual Special Needs Plans and Community Plans (Medicaid) are currently out of scope for these notification requirements. Exceptions are noted below for UMR Health Plans and Neighborhood Health Plan

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Rhinoplasty and Other Nasal Surgeries

(5 days ago) Benefit coverage for health services is determined by the member specific benefit plan document and applicable laws that may require coverage for a specific service. The documentation requirements outlined below are used to assess whether the member meets the clinical criteria for coverage but do not guarantee coverage of the service requested.

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COVID-19 Temporary Provisions

(2 days ago) health care professional. • COVID-19 tests purchased OTC without a prescription or health care professional’s involvement, such as those bought at a pharmacy or online, and processed without a lab or health care professional involvement, are not covered by the member’s benefits plan • Members will be responsible for the cost of OTC tests

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Prolonged Services Policy

(3 days ago) rendering health care services reporting the same Federal Tax Identification number. Reimbursement Guidelines . Oxford reimburses Prolonged Services when reported with E/M codes in which time is a factor in determining level of service in

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Behavioral Health Services

(1 days ago) All behavioral health providers . Reimbursement for the Behavioral Health and Evaluation and Management CPT Codes are subject to the billing requirements established by the American Medical Association (AMA) and the American Psychiatric Association (APA). CPT codes (90832-90834, 90836-90839, 90875-90876, and 90899) are time-based.

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Rebundling Policy, Professional

(5 days ago) health services and supplies/home health agencies. For the purpose of this policy, the Same Individual Physician or Other Qualified Health Care Professional is the same individual rendering health care services reporting the same Federal Tax Identification number. Reimbursement Guidelines Edit …

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Advance notification/prior authorization list

(5 days ago) The list of services that require advance notification and prior authorization is the same. The process for providing notification and submitting a prior authorization request is the same. Services that require prior authorization require a clinical coverage review based on medical necessity.

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Medical Nutrition Therapy (NCD 180.1)

(9 days ago) Benefit coverage for health services is determined by the member specific benefit plan document* and applicable laws that may require coverage for a specific service. The member specific benefit plan document identifies which services are covered, which are excluded, and which are subject to limitations.

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Gender Dysphoria Treatment

(2 days ago) Qualified Behavioral Health Provider: Recommended minimum credentials for behavioral health providers working with adults presenting with gender dysphoria (World Professional Association for Transgender Health [WPATH] Guidelines, version 7, 2012): o A minimum of a master’s degree or its equivalent in a clinical behavioral science field.

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Home Health and Hospice Telehealth Services UHCprovider.com

(3 days ago) Home Health and Hospice Telehealth Services. Last update: May 13, 2021, 11:09 a.m. CT. Home health and hospice agencies have a responsibility to help ensure that the use of telehealth is clinically appropriate and in accordance with the member’s care plan. UnitedHealthcare is continuing its expansion of telehealth access for certain visits

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Utah Health Plan Support Support by State

(2 days ago) Therapeutic Radiation Prior Authorization (IMRT, SRS, and SBRT) (For services to Medicare Advantage Customers only) Phone Number: 800-873-4575. What You Can Do When Calling this Number: Chiropractic, Physical Therapy, Occupational Therapy, and Speech Therapy Providers contracted with OptumHealth Physical Health, a UnitedHealth Group company.

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Speech Language Pathology Services

(Just Now) trained, the services are no longer skilled, therefore custodial, and not a covered health service. Refer to the Coverage Determination Guideline titled Skilled Care and Custodial Care Services. Mandated benefits (federal and state) for Speech and Language Therapy. Examples may include Developmental Delay, autism, cleft palate and/or lip, aphasia.

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Subrogation and coordination of benefits

(2 days ago) COBRA provides continued group health benefits to workers and families who lost coverage. COBRA generally requires group health plans with employers who have 20 or more employees, in the prior year, to offer continuation of coverage in certain instances where coverage would end. This coverage is available at the group premium rates.

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Sodium Hyaluronate

(Just Now) Benefit coverage for health services is determined by the member specific benefit plan document and applicable laws that may require coverage for a specific service. The documentation requirements outlined below are used to assess whether the member meets the clinical criteria for coverage but do not guarantee coverage of the service requested.

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UnitedHealthcare NexusACO

(3 days ago) Health plan coverage provided by UnitedHealthcare of Arizona, Inc., UHC of California DBA UnitedHealthcare of California, UnitedHealthcare Benefits Plan of Cali fornia, UnitedHealthcare of Colorado, Inc., UnitedHealthcare of the Mid-Atlantic, Inc., MAMSI Life and Health Insurance Company, UnitedHealthcare of New York, Inc.,

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Outpatient Hospital Observation Policy, Facility

(5 days ago) This reimbursement policy applies to all health care services billed on UB04 forms. Coding methodology, industry-standard reimbursement logic, regulatory requirements, benefits design and other factors are considered in developing reimbursement policy. This information is intended to serve only as a general reference resource regarding

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Electroencephalographic (EEG) Monitoring and Video

(2 days ago) Listing of a code in this policy does not imply that the service descrbi ed by the code is a covered or non -covered health service. Benefit coverage for health services is determined by the member specif ic benefit plan document and applicable laws that may require coverage for a specific service.

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Chromosome Microarray Testing (Non-Oncology Conditions)

(1 days ago) Benefit coverage for health services is determined by the member specific benefit plan document and applicable laws that may require coverage for a specific service. The documentation requirements outnli ed below are used to assess whether the member meets the clinci al criteria for coverage but do not guarantee coverage of the service requested.

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Pain Management and Pain Rehabilitation – Medicare

(9 days ago) Pain Management and Pain Rehabilitation Page 3 of 10 UnitedHealthcare Medicare Advantage Coverage Summary Approved 04/20/2021 Proprietary Information of UnitedHealthcare.

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2021 Care Provider Manual

(7 days ago) improved access to health care and reduced expenses. Care Model provides a care management/coordination team that helps increase member engagement, offers resources to fill gaps in care and develops personalized health goals using evidence-based clinical guidelines. This approach is essential to improving the health and

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Cardiac Event Monitoring

(6 days ago) Listing of a code in this policy does not imply that the service descrbi ed by the code is a covered or non -covered health service. Benefit coverage for health services is determined by the member specific benefit plan document and applicable laws that may require coverage for a specific service.

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Screening Pap Smears and Pelvic Examinations for Early

(Just Now) Benefit coverage for health services is determined by the member specific benefit plan document* and applicable laws that may require coverage for a specific service. The member specific benefit plan document identifies which services are covered, which are excluded, and which are subject to limitations.

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2020 2021 Care Provider Manual

(6 days ago) health provider or other specialists as required for complex needs. • Education and support with complex conditions. • Tools for helping members engage with providers, such as appointment reminders and help with transportation. • Foundation to build trust and relationships with hard-

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ERA Payer List for UnitedHealthcare, Affiliates and

(2 days ago) Sierra Health and Life ; 76342 CA, NV; UMR 39026; ALL UnitedHealthcare; 87726 ALL; UnitedHealthcare / All Savers Alternate Funding 81400; ALL UnitedHealthcare / All Savers Insurance; 81400 ALL; UnitedHealthcare / Oxford 06111; ALL UnitedHealthcare / UnitedHealthcare of the Mid-Atlantic, MD IPA, Optimum Choice and MAMSI Life and Health (formerly

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Ophthalmologic Policy: Vascular Endothelial Growth Factor

(2 days ago) Veterans Health Administration (USVHA) requires that only USVHA pharmacies may dispense bevacizumab for intravitreal administration to Veterans Administration beneficiaries. The medication must be dispensed directly to the VA ophthalmologist, who will then be responsible for preparing and administering the bevacizumab dose for each patient.

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Xolair® (Omalizumab) – Commercial Medical Benefit Drug …

(9 days ago) Listing of a code in this policy does not imply that the service described by the code is a covered or non-covered health service. Benefit coverage for health services is determined by the member specific benefit plan document and applicable laws that may require coverage for a specific service.

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Telehealth/Telemedicine Policy, Professional

(2 days ago) Physical Health, Occupational, and Speech Therapy . UnitedHealthcare will reimburse certain physical, occupational, and speech therapy (PT/OT/ST) Telehealth services provided by quali fied health care professionals rendered via interactive audio and video technology.

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Prolonged Services Policy, Professional

(3 days ago) qualified health care professional provides prolonged services beyond the usual service in either the inpatient or outpatient setting. Direct Patient Contact is face-to-face and includes additional non-face-to-face services on the patient’s floor or unit in the hospital or nursing facility during the same

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Gastrointestinal Pathogen Nucleic Acid Detection Panel

(5 days ago) Benefit coverage for health services is determined by the member specific benef it plan document and applicable laws that may require coverage for a specific service. The documentation requirements outnli ed below are used to assess whether the member meets the clinci al criteria for coverage but do not guarantee coverage of the service requested.

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Dental Clinical Policies and Coverage Guidelines

(Just Now) A monthly notice of recently approved and/or revised Dental Clinical Policies and Coverage Guidelines is provided below for your review. We publish a new announcement on the first calendar day of every month.. The appearance of a dental service (e.g., procedure or technology) in the Dental Policy Update Bulletin does not imply that UnitedHealthcare provides coverage for the dental …

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Radiologic Therapeutic Procedures

(7 days ago) Radiologic Therapeutic Procedures Page 1 of 7 UnitedHealthcare Medicare Advantage Coverage Summary Approved 03/16/2021 Proprietary Information of UnitedHealthcare.

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Prior Authorization Requirements for UnitedHealthcare

(Just Now) Behavioral health services . Many of our benefit plans only provide coverage for behavioral health services through a designated behavioral health network. For specific codes requiring prior authorization, please call the number on the member’s health plan ID card to refer for mental health and substance abuse/substance services.

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Claim correction and resubmission

(Just Now) When correcting or submitting late charges on a 1500 professional claim, use the following frequency code in Box 22 and use left justified to enter the code. Include the 12-digit original claim number under the Original Reference Number in this box. Frequency code 7 Replacement of Prior Claim: Corrects a previously submitted claim.

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