UHC September 2016 Network Bulletin

October 25, 2016

Quick Summary
Complete Network Bulletin Available Here

 
TABLE OF CONTENTS
Front & Center

• Communication Effectiveness Survey
• New and Updated Link Applications
• Tune in to UHC On Air
• Termination of the ICD-10 Code Look-up Tool
• Tell Us About Your Service Experience
• Cardiology Program Procedure Code Update – Effective Oct. 1, 2016
• Changes in Call Reference Number Procedures
• Changes in Advance Notification and Prior Authorization Requirements
• Prior Authorization Requirement for Certain Surgical Procedures Expanding to Include UnitedHealthcare Community Plan members in Delaware and Additional Procedures – Effective Oct. 1, 2016 in Most States UnitedHealthcare Medicare Solutions
• Transitional Care Management and Medication Reconciliation Post-Discharge — Complete to Meet Quality Standards and Improve Patient Health
• Medication Reconciliation Post-Discharge for Facilities — Support Closing This Open Care Opportunity to Help Prevent Readmissions
• Revision to Reimbursement Policy — Durable Medical Equipment Charges in a Skilled Nursing Facility
• Policy Reminder on Nonphysician Health Care Professionals Billing Evaluation and Management Codes
• Correct Reporting of Modifiers on Ipsilateral Organs or Structures
• New Policy–Patient Discharge Status for Type of Bill
• National Medicare Education Week: Helping to Make Medicare Easier to Understand
• UnitedHealthcare Medicare Advantage Coverage Summary Updates
• 2017 Medicare Advantage Service Area Reductions
UnitedHealthcare Commercial
• UnitedHealthcare Compass Network to Welcome Harken Health Members in 2017
• A Reminder about the Neighborhood Health Partnership Prior Authorization Policy
• UnitedHealthcare Medical Policy, Drug Policy and Coverage Determination Guideline Updates UnitedHealthcare Military & Veterans
• Avoid Delays by Using the Latest Care Request Form
UnitedHealthcare Commercial Reimbursement Policies
• Policy Revision to Nonphysician Health Care Professionals Billing Evaluation and Management Codes Doing Business Better
• Online Preventive Health Program Available for Information on Depression, Alcohol and Drug Abuse/Addiction and ADHD
• Evidenced-Based Clinical Practice Guidelines
• Reminder on Case and Disease Management Programs
UnitedHealthcare Community Plan
• Outpatient Injectable Chemotherapy Prior Authorization Program for UnitedHealthcare Community Plan in Ohio, Michigan, Mississippi and Wisconsin
• UnitedHealthcare Medical Policy & Coverage Determination Guideline Updates UnitedHealthcare Affiliates
• Oxford® Medical and Administrative Policy Updates
• SignatureValue/UnitedHealthcare Benefits Plan of
California Benefit Interpretation Policy Updates
• SignatureValue/UnitedHealthcare Benefits Plan of
California Medical Management Guideline Updates
 
FRONT AND CENTER (P 3)
 Communication Effectiveness Survey (P 3)
• 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
 
 New and Updated Link Applications (P 4)
• New Applications: Prior Authorization and Notification; eligibilityLink, claimsLink, My Practice Profile (formerly Provider Data Management)
• If you’re new to Link, you can get more information about using it at UnitedHealthcareOnline.com > Quick Links > Learn More.
• If you have questions, please call the UnitedHealthcare Connectivity Help Desk at 866-842-3278, option 3, 7 a.m. – 9 p.m. Central Time, Monday through Friday.
 
Tune in to UHC On Air (P 7)
• UHC On Air is live and on-demand video broadcasts created specifically for UnitedHealthcare care providers. 
• Access available through Link. To access Link, sign in to UnitedHealthcareOnline.com using your Optum ID. If you aren’t registered for UnitedHealthcareOnline.com and Link, please go to UnitedHealthcareOnline.com and select New User in the top right corner.
 
Termination of the ICD-10 Code Look-up Tool – Effective September 30, 2016 (P 8)
• 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.
 
 Tell Us About Your Service Experience (P 9)
• Each year, we ask for your participation in our Physician and Practice Manager Satisfaction Study.
• Survey invitations will be sent in September to a random sample of physicians and practice managers.
• As an appreciation for your participation, you may choose to enter a drawing for one of five prizes.
 
Cardiology Program Procedure Code Update – Effective Oct. 1, 2016 (P 10)
• Claims with dates of service on or after Oct.1, 2016 are subject to the changes.
• The full list of procedure codes requiring Notification or Prior Authorization in 2016 is available at UnitedHealthcareOnline.com > Clinician Resources > Cardiology. From this web page
• select Cardiology Notification & Prior Authorization for Commercial plans;
• select Medicare Advantage Cardiology Prior Authorization Program for Medicare plans; or
• select UnitedHealthcare Community Plan Cardiology Prior Authorization Program for Medicaid plans.
• The same procedure code list is used for all UnitedHealthcare plans.
 
Changes in Call Reference Number Procedures – Effective August 1, 2016 (P 10)
• UnitedHealthcare provider call representatives will no longer provide a 14-digit or 16-digit reference number.
• Call representatives will offer the last four digits of the reference number.
 
Changes in Advance Notification and Prior Authorization Requirements (P 11)
• Several services in the Home Health Services category will no longer require prior authorization for most Medicare Plans and Dual Medicare/Medicaid Plans.
• The most up-to-date Advance Notification lists are available online:
• UnitedHealthcare Medicare Solutions – UnitedHealthcareOnline.com > Clinician Resources > Advance & Admission Notification
• UnitedHealthcare Community Plan – UHCCommunityPlan.com > For Health Care Professionals > Select your State.
 
Prior Authorization Requirement for Certain Surgical Procedures Expanding to Include UnitedHealthcare Community Plan members in Delaware and Additional Procedures – Effective Oct. 1, 2016 in Most States (P 12)
• We are expanding our prior authorization requirement for certain surgical procedures to be covered in an outpatient hospital setting to include additional procedures.
• You do not need to request prior authorization to perform these procedures in a network ambulatory surgery center, unless the patient is a member of a plan that already requires it to evaluate medical necessity of the procedure in any setting.
• For more details, please go to UnitedHealthcareOnline.com > Tools & Resources > Policies, Protocols and Guides > Protocols > Prior Authorization for Outpatient Surgical Procedures FAQ.
• If you have questions, please contact your local Network Management representative or call the Provider Services number on the back of the member’s UnitedHealthcare ID card
 
UNITEDHEALTHCARE COMMERCIAL (P 14)

UnitedHealthcare Compass Network to Welcome Harken Health Members in 2017 (P 14)
• Not applicable in Michigan.
 
 A Reminder about the Neighborhood Health Partnership Prior Authorization Policy (P 17)
• Not applicable in Michigan.
 
 UnitedHealthcare Medical Policy, Drug Policy and Coverage Determination Guideline Updates (P 18)
• For complete details on the policy updates listed in the following table, please refer to the August 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.
 
UNITEDHEALTHCARE COMMERCIAL REIMBURSEMENT POLICIES (P 19)
Once implemented, the policies may be viewed in their entirety at UnitedHealthcareOnline.com > Tools & Resources > Policies and Protocols > Reimbursement Policies-Commercial.
 
Policy Revision to Nonphysician Health Care Professionals Billing Evaluation and Management Codes – Effective December 2016 (P 20)
• UnitedHealthcare will revise the Nonphysician Health Care Professionals Billing E/M Codes Policy to deny reimbursement of CPT codes 99201-99499 when reported by specific nonphysician health care the following professionals to better align with CMS and CPT: Optician; Surgical technician; Doctor of Naprapathy; Massage therapist; Acupuncturist
 
UNITEDHEALTHCARE COMMUNITY PLAN (P 16)
 Outpatient Injectable Chemotherapy Prior Authorization Program for UnitedHealthcare Community Plan in Ohio, Michigan, Mississippi and Wisconsin (P 21)
• Effective Oct. 1, 2016, UnitedHealthcare Community Plan members in Ohio, Mississippi, Michigan and Wisconsin will require prior authorization for injectable outpatient chemotherapy drugs given for a cancer diagnosis.
• This requirement has been in place for UnitedHealthcare’s Commercial members since June 1, 2015.
• To request prior authorization, go to UnitedHealthcareOnline.com > Notifications/Prior Authorizations > Oncology Authorizations Submission & Status or call 866-889-8054.
 
 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 Augusts 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 24)
Transitional Care Management and Medication Reconciliation Post-Discharge — Complete to Meet Quality Standards and Improve Patient Health (P 24)
• TCM services are the follow-up services you provide to your patients after they’ve been discharged from a hospital. Medication reconciliation is part of TCM and must be done within 30 days of an inpatient facility discharge.
• To learn more about medication reconciliation, please visit UnitedHealthcareOnline.com > Tools & Resources > Medicare > PATH > Transitional Care Management with Medication Reconciliation Post-Discharge.
 
Medication Reconciliation Post-Discharge for Facilities — Support Closing This Open Care Opportunity to Help Prevent Readmissions (P 25)
• Please send us our members’ discharge summary and medication lists immediately after discharge.
• We can receive discharge summary and medication lists in one of these ways:
• Electronic Medical Record (EMR) — If your EMR includes a discharge medication list and is accessible by both nursing and administrative staff, then we can get the information on our own if you’ve granted access to UnitedHealthcare
• Secure Fax: 844-563-5990.
• Email: discharge_summary@uhg.com.
• To learn more about medication reconciliation, please visit UnitedHealthcareOnline.com > Tools & Resources > Medicare > PATH > Medication Reconciliation Post-Discharge.
 
Revision to Reimbursement Policy — Durable Medical Equipment Charges in a Skilled Nursing Facility – Effective December 1, 2016 (P 26)
• The Durable Medical Equipment Charges in a Skilled Nursing Facility policy is being updated to include parental and enteral (PEN) supplies and equipment.
 
Policy Reminder on Nonphysician Health Care Professionals Billing Evaluation and Management Codes – Effective December 14, 2016 (P 26)
• UnitedHealthcare Medicare Advantage plans will implement prospective editing to the Nonphysician Health Care Professionals Billing Evaluation and Management Codes policy to deny reimbursement of CPT codes 99201-99499 when reported by a nonphysician care provider other than those defined by CMS.
 
Correct Reporting of Modifiers on Ipsilateral Organs or Structures – Effective December 14, 2016 (P 27)
• When the same anatomical modifier is submitted on a National Correct Coding Initiative (NCCI) Procedure to Procedure (PTP) code pair, the NCCI PTP edit will no longer be bypassed.
• For procedures performed on the ipsilateral organ or structure, most code pairs should not be reported with certain NCCI-associated modifiers unless there is a specific coding rationale to bypass the edit.
 
New Policy – Patient Discharge Status for Type of Bill – Effective December 14, 2016 (P 28)
• UnitedHealthcare will deny facility claims submitted on a UB-04 (or successor form) or the electronic equivalent where the Patient Discharge Status is not supported by the Type of Bill submitted.
• A Type of Bill reflective of an ongoing stay should align with a Patient Discharge Status reflective of a continued stay. Likewise, a Type of Bill reflective of a discharge should align with a Patient Discharge Status of where the patient was discharged to.
 
National Medicare Education Week: Helping to Make Medicare Easier to Understand (P 29)
• National Medicare Education Week, created by UnitedHealthcare, will be celebrated Sept. 15–21 to raise awareness of the importance of providing clear information about Medicare and help empower your patients to make informed, confident decisions about their Medicare coverage.
• You can participate by visiting MedicareMadeClear.com, where you can find information about the week, RSVP for events that will be held in select cities, and learn about Medicare.
 
 2017 Medicare Advantage Service Area Reductions (P 29)
• We will be sending official non-renewal notices by Oct. 2, 2016 to UnitedHealthcare Medicare Advantage members across the country who will be impacted by service area reductions in 2017.
• The non-renewal notice will give members information about their special election period eligibility for 2017 coverage.
• The majority of care providers and facilities contracted for UnitedHealthcare Medicare Advantage products will not be affected by these changes.
• To learn more and access frequently asked questions, please visit UnitedHealthcareOnline.com > Tools & Resources > Medicare, or contact your local Network Account Manager or Provider Advocate.
 
UnitedHealthcare Medicare Advantage Coverage Summary Updates (P 30)
• For complete details on the policy updates listed in the following table, please refer to the August 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 31)
• Not Applicable in Michigan
 
DOING BUSINESS BETTER (P 32)
• Online Preventive Health Program Available for Information on Depression, Alcohol and Drug Abuse/Addiction and ADHD (P 32)
• A convenient, reliable and free source of pertinent health information, the preventive health program includes a library of articles addressing aspects of each condition; information about co-morbid conditions; links to nationally recognized practice guidelines; a printable self-appraisal to use or refer your patients to; and a listing of support resources for you, your patients and their families.
• Physicians and other health care professionals may access the program at liveandworkwell.com/member/prevention/.
 
Evidenced-Based Clinical Practice Guidelines (P 33)
• Clinical practice guidelines are available at UnitedHealthcareOnline.com > Tools & Resources > Policies, Protocols and Guides > Medical & Drug Policies and Coverage Determination Guidelines > Clinical Guidelines.
• COPD guidelines have undergone significant changes.
 

 Reminder on Case and Disease Management Programs (P 38)
• As a reminder, UnitedHealthcare offers case and disease management programs to support care providers’ treatment plans and assist members in managing their conditions.
• Case Management: At the core of case management is identifying high-cost, complex, at-risk members who can benefit from these services.
• Disease Management: We offer disease management programs designed to provide members with specific conditions the appropriate level of intervention.
 
UNITEDHEALTHCARE AFFILIATES (P 38)
• Not Applicable in Michigan