UnitedHealthcare has shared their Network News updates for June 2023.
Going Digital!
We will no longer mail several key medical claim-related letters and documents. Instead, network medical health plan professionals and facilities will be able to view the letters 24/7 through several digital options. These are the effective dates for each product. Digital and paperless initiatives | UHCprovider.com
Upcoming transitionsTiming Commercial plans: Claim lettersAug. 4, 2023Medicare Advantage Plans: Claim lettersJuly 1, 2023Michigan: UnitedHealthcare Community Plan provider remittance advice (PRAs) and medical claim-related lettersJune 2, 2023
Michigan: Medicaid claim letters are going paperless
(See attached)
Sept. 8, 2023
Each of these transitions may require a change to way you work today. We encourage you to start sharing this information and review our digital solution options. If you work with an outside vendor for your mail processing, such as a revenue cycle management company, please discuss how this change may affect your contract or processing arrangements.
You can submit pre-service appeals digitally
Did you know there’s another way to submit medical pre-service appeals?
Network and out-of-network health care professionals (primary and ancillary) and facilities that provide services to UnitedHealthcare® Medicare Advantage, UnitedHealthcare Community Plan and Dual Special Needs Plan (D-SNP) plan members can now submit pre-service appeals electronically.
https://www.uhcprovider.com/en/resource-library/news/2023/submit-pre-service-appeals-digitally.html
UnitedHealthcare Shared Services members can access our network
UnitedHealthcare Shared Services is a service model that gives plan sponsors access to the UnitedHealthcare network but allows them to self-administer plan benefits or have a third-party administrator (TPA) administer benefits on their behalf. This means you can treat members with UnitedHealthcare Shared Services because they have access to our network. (See attached)
New clinical pharmacist-led medication optimization program
New clinical pharmacist-led medication optimization program
This pharmacist-led program evaluates medication therapy for indication, effectiveness, safety and the patient’s ability to take their medications as prescribed. We use data obtained through pharmacy claims, medical claims and self-reporting.
Earn Bonus Payments through the Doula Care Bonus Program
UnitedHealthcare Community Plan of Michigan is excited to offer your practice the opportunity to earn bonus payments through our Doula Care Bonus Program (the “program”) for your important work in ensuring our Medicaid UnitedHealthcare Community Plan of Michigan members (“members”) receive the prenatal and postpartum care they need.
Program overview
For dates of service from April 1, 2023, through March 31, 2025, (the “program period”) you can earn:
- $50.00 for timely medical prenatal or postpartum services received by a member to which you are providing doula services in accordance with the HEDIS® Prenatal and Postpartum Care (PPC) measure, based on claims in our system
- $50.00 for each member who has received a breast pump within 30 days before or after the delivery, as indicated by a claim in our system with CPT® code E0602, E0603 or E0604
- Limited to 1 per member per program period
Doula Care Bonus Program payment
UnitedHealthcare will pay the Doula Care Bonus Program payment as the sum of the rendered services described in this letter using claims in our system no later than [90] days after the last date of the quarter. All payments under this Doula Care Bonus Program are in addition to the payments you currently receive for covered services.
Important UnitedHealthcare Medicare Advantage post-acute care requirements
Important UnitedHealthcare Medicare Advantage post-acute care requirements
Facilities contracted with UnitedHealthcare and providing post-acute inpatient services for UnitedHealthcare® Medicare Advantage members are required to obtain prior authorization before members can be admitted to a post-acute care facility.
https://www.uhcprovider.com/en/resource-library/news/2022/prior-auth-post-acute-medicare-adv.html
Updated requirements for Gastroenterology Services
On June 1, 2023, UnitedHealthcare will require advance notification for non-screening gastroenterology procedures.
Join us for a Surest live webinar and Q&A
Stumped on how to work with Surest benefit plans? Get all the information you need, and ask all the questions you have, in our upcoming live webinar.
June 29, 2023, 12–12:45 p.m. CDT
Webinar highlights
- Discover how to help ensure your billing and registration systems are set up correctly for Surest members
- Learn about how the plans don’t have deductibles or coinsurance and members can check costs and care options in advance
- Review the new Surest member ID card and learn what you need to look for
- Get details about how we’ve updated the UnitedHealthcare Provider Portal and Surest Provider Line to better serve you
- Participate in an interactive, chat-based Q&A
The webinar will be presented by Mitch Knippenberg, network solutions specialist, Surest.
Questions?
Please contact providers@surest.com.
UnitedHealthcare Community Plan MIHP
Quick Reference Guide to access MIHP Services and Billing Resources. (See attached)
UnitedHealthcare Provider Portal Resources
You can access patient- and practice-specific information 24/7 that helps you complete tasks, get updates to claims, reconsiderations and appeals, submit prior authorization requests and check eligibility — all at no cost — without having to pick up the phone. (See attached)