UHC October 2016 Network Bulletin

October 25, 2016

Quick Summary

Complete Network Bulletin Available Here

 

TABLE OF CONTENTS

Front & Center

• Tell Us About Your Experience With Us

• New National Drug Code (NDC) Requirement Policy

• Communication Effectiveness Survey

• Evaluation and Management Reimbursement Policy

• Changes in Advance Notification and Prior Authorization Requirements: Code Removals from Existing Prior Authorization Categories

• Dental Clinical Policy and Coverage Guideline Updates

 

 

UnitedHealthcare Commercial Reimbursement Policies

• Multiple Procedure Payment Reduction for Diagnostic Cardiovascular Procedures – Revision to Remove Global Test Only Codes

 

UnitedHealthcare Commercial

• Notification/Prior Authorization Requirements for Specialty Medications

• Reminder: Your 2016 UnitedHealth Premium® Designation Program Letter Coming in November

• Changes to the UnitedHealthcare Compass Network Service Area – Effective Jan. 1, 2017

• UnitedHealthcare Compass Network Will Welcome Harken Health Members in 2017

• iFOBT In-Home Screening Program

• Care Providers Can Help Facilitate HEDIS Data Collection

• Laboratory Benefit Management Program Pilot Launching March 1, 2017 in Texas

• New Admission Notification, Advanced Notification and Prior Authorization Requirements for All Savers Insurance Company

• UnitedHealthcare Medical Policy, Drug Policy and Coverage Determination Guideline Updates

 

UnitedHealthcare Community Plan

• Preferred Drug List Changes

• Outpatient Injectable Chemotherapy Prior Authorization Program for UnitedHealthcare Community Plan in New Jersey, New York, Texas and Pennsylvania

• UnitedHealthcare Community Plan Medical Policy & Coverage Determination Guideline Updates

 

UnitedHealthcare Medicare Solutions

• Helping Members Make Informed Decisions During Medicare Open Enrollment

• New Medicare Advantage Referral Required Plans

• UnitedHealthcare Medicare Advantage Coverage Summary Updates

 

UnitedHealthcare Military & Veterans

• Not Applicable in Michigan

 

UnitedHealthcare Affiliates

• Not Applicable in Michigan

 

FRONT AND CENTER (P 3)

Tell Us About Your Experience With Us (P 3)

Survey invitations have been sent to a random sample of physicians and practice managers.
If you receive an invitation to participate in this year’s study, we hope you will take a few minutes to complete the survey and share your experiences and perspectives.

 

New National Drug Code (NDC) Requirement Policy – Effective Jan. 1, 2017 (P 4)

Claims submitted for reimbursement for drug-related codes for UnitedHealthcare Commercial and UnitedHealthcare Medicare Advantage members must include the NDC number, quantity and the unit of measure.
If you do not include the NDC with your claims submission, your claim may be denied and you will be notified through a Provider Remittance Advice (PRA) to resubmit the claim with the NDC information.
FAQ document attached

 

Communication Effectiveness Survey (P 4)

Please take a few moments to answer our brief three-question survey so we can continue to improve our communications to you.
The survey is available online at uhcresearch.az1.qualtrics.com/jfe/form/SV_a2TkHLsEbvfxGgB

 

Evaluation and Management Reimbursement Policy  - Effective Sept. 1, 2016 (P 5)

Previously announced in the June 2016 and July 2016 Network Bulletins.
The policy provides additional guidance in determining the appropriate E/M codes for services in the range 99201 – 99350. It also contains a section for E/M services performed in an Emergency Department (ER/ED) place of service, providing further details regarding additional work up planned for codes 99281 - 99285.

 

Changes in Advance Notification and Prior Authorization Requirements: Code Removals from Existing Prior Authorization Categories – Effective on or after Jan. 1, 2017 (P 6)

Some codes will no longer require prior authorization for UHC Commercial, Community Plan, and Medicare Solutions. The updated requirements will be posted in early December 2016.
UnitedHealthcare thanks care providers for their efforts in making the transition to ICD-10 a success and for the care you provide on behalf of our members.
A new category for prior authorization – Gender Dysphoria Treatment – will be implemented for UHC Commercial and Medicare Solutions.
Some new codes will be added to categories already requiring prior authorization for UHC Medicare Solutions.
The most up-to-date Advance Notification lists are available online:

UnitedHealthcare Medicare Solutions and UnitedHealthcare Commercial Plan – UnitedHealthcareOnline.com > Clinician Resources > Advance and Admission Notification Requirements.
UnitedHealthcare Community Plan – UHCCommunityPlan.com > For Health Care Professionals > Select your state.

 

Dental Clinical Policy and Coverage Guideline Updates (P 10)

For complete details on the policy updates listed in the following table, please refer to the September 2016 UnitedHealthcare Dental Policy Update Bulletin at UnitedHealthcareOnline.com > Tools & Resources > Policies, Protocols and Guides > Dental Clinical Policies & Coverage Guidelines > Update Bulletin.

 

UNITEDHEALTHCARE COMMERCIAL (P 11)

Notification/Prior Authorization Requirements for Specialty Medications – Effective Jan. 1, 2017 (P 11)

This addition applies to UHC Commercial plans.
UnitedHealthcare will require notification for the following specialty medications: Cinqair® (reslizumab) and Nucala® (mepolizumab); Gonadotropin Releasing Hormone (GnRH) Analogs; OcrevusTM (ocrelizumab); and Probuphine® (buprenorphine) subdermal implant.
We will inform you and the member of the coverage determination made pursuant to our prior authorization process within 15 days after the date we receive all required information from you and, if an adverse determination is made, we will provide you appeal information.
Failure to complete the notification/prior authorization process prior to the administration or insertion of any of these specialty medications will result in claim denial
For more information about the notification/prior authorization requirements for specialty medications, please refer to the Physician Health Care Professional, Facility and Ancillary Provider Administrative Guide at UnitedHealthcareOnline.com > Tools & Resources > Policies, Protocols and Guides > Administrative Guides.

 

Reminder: Your 2017 UnitedHealth Premium® Designation Program Letter Coming in November (P 13)

The designations are publicly displayed on Jan. 4, 2017. Prior to the effective date of the designations, we will provide time for you to review your assessment results and request reconsideration, if applicable.
As previously communicated to you in the July Network Bulletin, the UnitedHealth Premium designation program will use new icons to indicate the designations of physicians in the provider directory beginning January 2017 (see network bulletin for icon details).
For more information about UnitedHealth Premium, go to UnitedHealthcareOnline.com > Quick Links > UnitedHealth Premium or call 866-270-5588.

 

Changes to the UnitedHealthcare Compass Network Service Area – Effective Jan. 1, 2017 (P 14)

To view the 2017 UnitedHealthcare Compass network service area map, visit UnitedHealthcareOnline.com > Tools & Resources > Products & Services > UnitedHealthcare Compass > 2017 Compass Network Service Area.
Care providers located outside the 2017 UnitedHealthcare Compass network service area will be considered out of area for UnitedHealthcare Compass benefit plans. Services provided outside the 2017 service network service area are not a covered benefit for Compass benefit plans, except for urgent or emergency services.

 

UnitedHealthcare Compass Network Will Welcome Harken Health Members in 2017 – Effective Jan. 1, 2017 (P 16)

Not applicable in Michigan.

 

iFOBT In-Home Screening Program (P 17)

That’s why we offer the in-home immunochemical fecal occult blood test (iFOBT) as an alternative screening option when a colonoscopy is not practical.
For more information on the program, please go to UnitedHealthcareOnline.com > Tools & Resources > Medicare > PATH > 2016 iFBOT Program Overview. For more information about how our programs can help support your patients who are UnitedHealthcare members, contact your UnitedHealthcare representative.

 

Care Providers Can Help Facilitate HEDIS Data Collection (P 18)

Beginning in January 2017, we will be contacting you to request member-specific medical record information to comply with federal, state and accreditation requirements.
Here are some steps care providers can take to help facilitate the HEDIS data collection process:

Submit accurate and timely claims for every office visit
Be specific on diagnosis coding and always use the most appropriate diagnosis code available
Document all care in the patient’s medical record
Keep accurate, legible and complete medical records
Chart documentation should reflect all services billed
Submit diagnosis codes that address the patient’s documented history. These codes should be documented for new patients on the initial visit claim.
If your office is contacted, please respond within five business days. A timely response helps ensure the information we report is accurate and reflects the high quality care that you strive to provide.
Utilize UnitedHealthcare’s HEDIS Reference Guides for more specific information on the HEDIS measures.

If you have questions or concerns regarding HEDIS, please visit UnitedHealthcareOnline.com or contact your UnitedHealthcare representative, who can provide additional information related to the HEDIS Adult, Pediatric and Women’s Health Reference Guides.

 

Laboratory Benefit Management Program Pilot Launching March 1, 2017 in Texas (P 19)

Not applicable in Michigan.

 

New Admission Notification, Advanced Notification and Prior Authorization Requirements for All Savers Insurance Company – Effective on or after Jan. 1, 2017 (P 20)

With some exceptions (see Network Bulletin for exceptions), the Advance Notification, Prior Authorization and Admission Notification requirements detailed on pages 31 – 39 in the UnitedHealthcare Physician, Health Care Professional, Facility and Ancillary Provider 2016 Administrative Guide for Commercial and Medicare Advantage Products will apply to All Savers Insurance Company commercial benefit plans offered off-exchange with Group Numbers 908867 and 908868.
The Administrative Guide is available at UnitedHealthcareOnline.com > Tools & Resources > Policies, Protocols and Guides > Administrative Guides. For more information, call the number on the back of the member’s ID card.

 

UnitedHealthcare Medical Policy, Drug Policy and Coverage Determination Guideline Updates (P 21)

For complete details on the policy updates listed in the following table, please refer to the applicable Medical Policy Update Bulletin at UnitedHealthcareOnline.com > Tools & Resources > Policies, Protocols and Guides > Medical & Drug Policies and Coverage Determination Guidelines > Medical Policy Update Bulletin.

 

UNITEDHEALTHCARE COMMERCIAL REIMBURSEMENT POLICIES (P 24)

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

 

Multiple Procedure Payment Reduction for Diagnostic Cardiovascular Procedures – Revision to Remove Global Test Only Codes (P 25)

Effective for UnitedHealthcare Commercial Plan claims with a date of service on or after June 1, 2016, UnitedHealthcare implemented the CMS Multiple Procedure Payment Reduction (MPPR) of 25% to the technical component (TC) of TC-only services and to the TC portion of global services reported for diagnostic cardiovascular procedures.
Due to operational issues, effective August 28, 2016, UnitedHealthcare removed the Global Test Only codes CPT codes 93000, 93015, 93040, 93224, 93268 and 93784 from applying the MPPR reductions to these cardiovascular codes

 

UNITEDHEALTHCARE COMMUNITY PLAN (P 27)

Preferred Drug List Changes (P 27)

Not applicable in Michigan.

 

Outpatient Injectable Chemotherapy Prior Authorization Program for UnitedHealthcare Community Plan in New Jersey, New York, Texas and Pennsylvania (P 30)

Not applicable in Michigan.

 

UnitedHealthcare Community Plan Medical Policy & Coverage Determination Guideline Updates (P 31)

For complete details on the policy updates listed in the following table, please refer to the applicable 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 34)

Helping Members Make Informed Decisions During Medicare Open Enrollment (P 34)

Medicare Open Enrollment will be conducted Oct. 15 to Dec. 7, 2016.
You can help your patients make informed, confident decisions about their Medicare coverage by directing them to MedicareMadeClear.com.

 

New Medicare Advantage Referral Required Plans – Effective Jan. 1, 2017 (P 35)

To view a full list of referral-required plans, go to UnitedHealthcareOnline.com > Tools & Resources > Products & Services > Medicare.
Specialists are required to confirm an active referral is recorded on Link or UnitedHealthcareOnline.com before services are rendered.

 

UnitedHealthcare Medicare Advantage Coverage Summary Updates (P 36)

For complete details on the policy updates listed in the following table, please refer to the September 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 37)

Not Applicable in Michigan

 

UNITEDHEALTHCARE AFFILIATES (P 40)

-Not Applicable in Michigan