Please see your United Healthcare May 2023 Network News updates:
Want to help secure accurate and timely payments? Verify your data!
Health care professionals who are contracted with UnitedHealthcare are required to verify demographic data every 90 days.
How do I verify my data?
- CAQH® ProView®
- My Practice Profile
- CAQH® ProView® for Groups
- Roster Management program
COVID-19 PHE ends on May 11, 2023
On Jan. 30, 2023, the White House announced the COVID-19 national emergency and public health emergency (PHE) will expire at the end of the day on May 11, 2023. This means some of the temporary programs, processes and procedures UnitedHealthcare implemented as a result of COVID-19 will also end on May 11, 2023.
To learn more about what’s changing, please see our COVID-19 Information & Resources.
For Medicaid and other state-specific requirements, please refer to state-specific Medicaid websites or your state’s UnitedHealthcare Community Plan website, if applicable.
More claim letters are going paperless Aug. 4 (see attachment)
Beginning Aug. 4, 2023, UnitedHealthcare will no longer mail claim letters to most* medical network health care professionals and facilities for UnitedHealthcare commercial plans. While many claim letters have already moved to digital, these can be found in the Document Library Claim Letters folder. You’ll be able to view them 24/7 through the UnitedHealthcare Provider Portal or an Application Programming Interface (API).
If you use an outside vendor, such as a revenue cycle management company or lockbox service, please ensure they’re aware of the following changes and digital workflow options.
2023 in-home screening outreach underway (see attachment)
As part of our in-home screening outreach program, eligible UnitedHealthcare commercial plan members may receive one of the following throughout May and June:
- A Fecal Immunochemical Test (FIT) based on their prior completion of a screening
- A letter or email allowing them to opt in via an online web portal to receive an at-home FIT screening kit beginning in May
- A letter or email encouraging them to order a Hemoglobin A1C (HbA1c), estimated glomerular filtration rate (eGFR) or a urine albumin-creatinine ratio (uACR) screening kit
- A phone call to schedule an in-home retinal eye exam with the option of receiving an at home A1C or FIT kit when applicable
Annual commercial plan federal audit (see attachment)
Submit member medical records to comply
As a UnitedHealthcare commercial plan network health care professional, you may be randomly selected to provide members’ medical records for the Department of Health and Human Services (HHS) annual Risk Adjustment Data Validation (RADV) Program audit. We are asking various health care professionals to provide the supporting medical documentation of our members’ medical services for review.
Telehealth documentation requirements
When you see a patient for a telehealth visit, you should document the visit at the same level as an in-person visit, reflecting exactly what was done during the visit. This helps ensure accurate claims and billing processes. It's also important to document that you performed the visit through audio-video telecommunications.
Telehealth claims reviews
As explained in the UnitedHealthcare Care Provider Administrative Guide for Commercial and Medicare Advantage, we have the right to assess health care provider records to determine the accuracy of CPT® coding. You can find information about our requirements related to medical records in chapter 12.
Get paid faster for lab claims
If a lab test is billed and it does not match the level of Clinical Laboratory Improvement Amendment (CLIA) certification, we will let you know through a Smart Edit on your 277CA clearinghouse rejection report so you can respond- speeding up claims processing so you get paid faster. Please refer to the Smart Edits Homepage.
5 levels of CLIA certification:
- Certificate of Waiver
- Certificate for Provider-Performed Microscopy Procedures (PPMP)
- Certificate of Registration
- Certificate of Compliance
- Certificate of Accreditation
If your certification level is a certificate of waiver, you may only bill tests granted under waived status.
The use of the QW modifier may be necessary when billing a CLIA waived test with Waiver or PPMP/Microscopy level certification. When there are situations like an Emergency Use Authorization (EUA), additional tests may be deemed as CLIA waived tests and also require the QW modifier.
Information on these additional codes can be found through Centers for Medicare and Medicaid Services (CMS) transmittals and Medicare Learning Network (MLN) Matters articles on the CMS website.
- Clinical Laboratory Improvement Amendments (CLIA) ID Requirement Policy. Select line of business > Reimbursement Policy
- Smart Edits Homepage
- Explore the new gastroenterology prior authorization web page
In a March Network News update, we told you about new prior authorization requirements for gastroenterology services that begin on June 1, 2023.
Please visit the new UHCprovider.com Gastroenterology Prior Authorization and Notification page for more information.
On this page you will find:
- Updated guidelines for UnitedHealthcare commercial plans
- Updated guidelines for UnitedHealthcare Oxford plans
- Prior authorization for gastroenterology services FAQ
- Prior Authorization CPT® Code List and Crosswalk Table