UHC Network Bulletin – May 2016

June 7, 2016

Quick Summary:  Complete Network Bulletin Available Here

FRONT AND CENTER (P 3)

Quality Improvement Programs Make Great Strides (P 3)

  • Each year we evaluate our Quality Improvement programs to assess progress in meeting member-centric goals.
  • We reached several milestones in all lines of business. See the Network Bulletin for a complete list.

 

UnitedHealthcare Contracts with Fixed-Wing Air Ambulance Services (P 5)

  • Three providers have joined UHC fixed-wing ambulance network: AirCARE1 International, AMR Air Ambulance, Medway Air Ambulance
  • The Air Ambulance Fixed-Wing Non-Emergency Transport Protocol is available in the Physician, Health Care Professional, Facility and Ancillary Provider 2016 Administrative Guide, page 56, at UnitedHealthcareOnline.com > Tools and Resources > Policies, Protocols and Guides > UnitedHealthcare Administrative Guide 2016.

 

Collaboration between PCPs and Behavioral Health Clinicians Can Make a Difference (P 6)

  • Please discuss with your patients the benefits of sharing essential clinical information.
  • When applicable, we encourage you to obtain a signed release from each UnitedHealthcare member that allows you to share appropriate treatment information with their behavioral health clinician.

 

AxelaCare Joins UnitedHealthcare Network of Infusion Services Providers (P 6) – Effective February 1, 2016   NOT AVAILABLE IN MICHIGAN

  • For more information, go to UnitedHealthcareOnline.com >Tools & Resources > News & Network Bulletin > UnitedHealthcare News > AxelaCare Joins UnitedHealthcare Network of Infusion Services Providers, Effective Feb. 1, 2016.

 

Medtronic to Become UnitedHealthcare’s Preferred DME Provider of Insulin Pumps for Diabetes – Effective July 1, 2016 (P 7)

  • The preferred relationship excludes Medicare Advantage
  • UnitedHealthcare will continue to cover insulin pump supplies for all brands of insulin pumps that our members currently use while their insulin pumps are in warranty and are still functioning properly.
  • There has been no change within our medical policy for coverage of insulin pumps; this only applies to the type of device prescribed.
  • When UnitedHealthcare members need to obtain their prescribed pump, they can call Medtronic at 800-646-4633 or visit www.medtronicdiabetes.com/preferred.

 

UNITEDHEALTHCARE COMMERCIAL (P 8)

Participation Status in Harken Health Benefit Plans 2016 (P 8)  - Copy of ID card, mailing address, etc… in the complete Network Bulletin

  • Harken Health Insurance Company is an affiliate of UnitedHealthcare that offers competitively priced benefit plan options that focus on relationship-based primary care for members in certain counties in Georgia and Illinois.
  • If you participate in UnitedHealthcare’s Choice Plus network, you are also a participating provider in the Harken Health network.
  • To confirm member eligibility, please visit provider.harkenhealth.com or call Harken Health at 800-797-9921.

 

Reminder to Use Network Laboratories (P 11)

  • In Access the current list of participating laboratories at UnitedHealthcareOnline.com > Physician Directory > General Physician Directory > Select a Plan > Laboratory > Enter Zip Code > Select Laboratory.
  • If a member chooses to receive services from a non-network lab, you must complete the Member Advance Notice Form, which can be found at UnitedHealthcareOnline.com > Tools & Resources > Policies, Protocols and Guides > Protocols > UnitedHealthcare Member Advance Notice Form, obtain the member’s signature on the form and keep it for your records.
  • If you have any questions, please contact your Physician or Hospital and Facility Advocate or call 877-842-3210. You may also refer to the Provider Administrative Guide at UnitedHealthcareOnline.com.

 

UnitedHealthcare Medical Policy, Drug Policy and Coverage Determination Guideline Updates (P 12)

  • For complete details on the policy updates, please refer to the April 2016 Medical Policy Update Bulletin at UnitedHealthcareOnline.com > Tools & Resources > Policies, Protocols and Guides > Medical & Drug Policies and Coverage Determination Guidelines > Medical Policy Update Bulletin.

 

Dental Clinical Policy & Coverage Guidelines Updates (P 12)

  • For complete details on the policy updates listed in the following table, please refer to the March 2016 UnitedHealthcare Dental Policy Update Bulletin at UnitedHealthcareOnline.com > Tools & Resources > Policies, Protocols and Guides > Dental Clinical Policies & Coverage Guidelines > Update Bulletin. All of these policy updates are effective April 1, 2016.

 

UNITEDHEALTHCARE COMMERCIAL REIMBURSEMENT POLICIES (P 16)

  • Once implemented, the policies may be viewed in their entirety at UnitedHealthcareOnline.com > Tools & Resources > Policies and Protocols > Reimbursement Policies-Commercial.

 

Delay to Revision of the Bilateral Procedures Policy (P 17)

  • The revision to UnitedHealthcare’s Bilateral Procedures Policy for Commercial plans will take effect in the third quarter of 2016 instead of the second quarter of 2016 as previously announced.
  • For details about this revision, please refer to the February 2016 Network Bulletin.

 

Revision to the Durable Medical Equipment, Orthotics and Prosthetics Multiple Frequency Policy (P 17)

  • UnitedHealthcare’s Durable Medical Equipment, Orthotics and Prosthetics Multiple Frequency Policy for Commercial plans will be revised in the third quarter of 2016.

 

CCI Editing Policy Coding Reminder: Correct Reporting of Modifiers on Ipsilateral Organs or Structures (P 18)

  • Modifiers which are recognized by UnitedHealthcare in the CCI (Correct Coding Initiative) Editing policy follow the Centers for Medicare & Medicaid Services (CMS) National Correct Coding Initiative (NCCI) designated modifiers for Procedure-to-Procedure (PTP) edits.

 

UNITEDHEALTHCARE COMMUNITY PLAN (P 19)

Preventive Care Opportunity Information to be Included in UnitedHealthcare Community Plan EDI Responses (P 19)

  • The preventive care opportunities information is featured in the supplemental messages/comment fields of the EDI response. For integrated practices, this may be visible in a ‘Comments’ or ‘Other information’ system section when searching for and viewing your patients who are UnitedHealthcare Community Plan members.
  • For more information on this and other EDI transactions, please visit UnitedHealthcareOnline.com > Tools and Resources > EDI Education for Transactions > Eligibility Benefit Inquiry & Response (270/271) (under the section titled: Other electronic transactions). If you have questions, please contact our EDI help line at 800-210-8315 or ac_edi_ops@uhc.com.

 

UnitedHealthcare Community Plan Medical Policy & Coverage Determination Guideline Updates (P 22)

  • For complete details on the policy updates listed in the following table, please refer to the April 2016 Medical Policy Update Bulletin at UHCCommunityPlan.com > For Health Care Professionals > Select Your State > Provider Information > UnitedHealthcare Community Plan Medical Policies and Coverage Determination Guidelines.

 

UNITEDHEALTHCARE MEDICARE SOLUTIONS (P 23)

UnitedHealthcare Medicare Advantage Coverage Summary Updates (P 23)

  • For complete details on the policy updates listed in the following table, please refer to the March 2016 Medicare Advantage Coverage Summary Update Bulletin at UnitedHealthcareOnline.com > Tools & Resources > Policies, Protocols and Guides > UnitedHealthcare Medicare Advantage Coverage Summaries > Update Bulletin.

 

UNITEDHEALTHCARE MILITARY AND VETERANS (P 25)

Avoid Delays when Submitting Referral or Authorization Care Requests (P 25)

  • Does not affect Michigan Market