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UnitedHealthcare Provider Portal UHCprovider.com

Details: Information and resources for our online self-service tools on the UnitedHealthcare provider portal. On the portal you can get member eligibility, benefits, claims and referral information for multiple UnitedHealthcare plans, all in one location.

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UHCprovider.com Home UHCprovider.com

Details: UnitedHealthcare's home for Care Provider information with 24/7 access to Link self-service tools, medical policies, news bulletins, and great resources to support administrative tasks including eligibility, claims and prior authorizations.

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› Url: https://www.uhcprovider.com/ Go Now

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Find a Care Provider UHCprovider.com

Details: Optum's Centers of Excellence networks are the gold standard in complex health care. Our original network, the Optum Transplant Centers of Excellence network, was developed in 1986 and has grown to be the largest network of its kind in the world, managing more than 14,000 transplant referrals in 2013.

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Treatment & Cost Share Guidance UHCprovider.com

Details: UnitedHealthcare is updating testing guidelines, coding and reimbursement information for the COVID-19 health emergency, based on guidance from the Centers for Medicare & Medicaid Services (CMS), the Centers for Disease Control and Prevention (CDC), state and federal governments and other health agencies. Check back often for updates.

› Verified 7 days ago

› Url: https://www.uhcprovider.com/en/resource-library/news/Novel-Coronavirus-COVID-19/covid19-testing/covid19-treatment-guidance.html Go Now

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Point of Care Assist® UHCprovider.com

Details: personalize health care and ease administrative burdens by delivering seamless, patient-centered, real-time data right into your workflow at the time of care. The outcome? [Text on screen: Better care, Greater value, Improved health outcomes, lower patient costs. Better care, greater value, improved health outcomes, and lower costs for your

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Designated Diagnostic Provider UHCprovider.com

Details: In an effort to reduce member cost and improve transparency, we’ve created, subject to state regulatory approval, Designated Diagnostic Provider (DDP) benefit designs. For fully insured commercial plan members, outpatient laboratory services will only be covered when delivered by freestanding or hospital lab providers who meet certain quality and efficiency requirements.

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› Url: https://www.uhcprovider.com/en/reports-quality-programs/designated-diagnostic-provider.html Go Now

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Optum ID name changing to One Healthcare ID UHCprovider.com

Details: Optum ID name changing to One Healthcare ID. Last modified: April 12, 2021. On the evening of April 9, 2021, Optum ID was re-named One Healthcare ID as part of our digital initiatives, technology updates and migration of UnitedHealthcare services to a new cloud platform. What this change means for you.

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Network Bulletin UHCprovider.com

Details: Changes to these effective dates or updates to our business practices and policies as a result of COVID-19 will prevail and be posted on our care provider website as quickly as possible. As with any public health issue, we are working with and following guidance and protocols issued by federal, state, and local health authorities.

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2021 UnitedHealthcare Care Provider Administrative Guide

Details: workers’ compensation or other government programs. “Commercial” also applies to benefit plans for the Health Insurance Marketplace, government employees or students at public universities. • “You,” “your” or “provider” refers to any health care provider subject to this guide. This includes physicians, health …

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National Drug Code Requirements

Details: • RJ Health Systems’ reimbur sementcodes.com, an NDC coding product • Optum360’s drugreimbursement.com, which includes NDC coding. Submitting Claims with NDC Information . What’s included in the required NDC information? When you’re submitting a claim with NDC information, you must include: • The valid 11-digit NDC number

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› Url: https://www.uhcprovider.com/content/dam/provider/docs/public/claims/NDC-Requirement-FAQ.pdf Go Now

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EDI 837: Electronic Claims UHCprovider.com

Details: The EDI 837 Health Care Claim transaction is the electronic transaction for claims submissions. UnitedHealthcare accepts the following claim types from both participating and non-participating care providers: 837P: Professional (physician) and vision claims. 837I: Institutional (hospital or facility) claims. 837D: Dental claims.

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Practice Administration UHCprovider.com

Details: To notify UnitedHealthcare of a new health care professional joining your medical group during the COVID-19 national public health emergency period: Please either follow your normal process to submit a request to add a new health care professional to your TIN or contact your network management team. Indicate that the change is related to COVID-19.

› Verified 6 days ago

› Url: https://www.uhcprovider.com/en/resource-library/news/Novel-Coronavirus-COVID-19/covid19-practice-administration.html Go Now

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Skin and Soft Tissue Substitutes

Details: Benefit coverage for health services is determined by the member specific benefit plan document and applicable laws that may require coverage for a specific service. The documentation requirements outnli ed below are used to assess whether the member meets the clinci al criteria for coverage but do not guarantee coverage of the service request ed.

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Cell-Free Fetal DNA Testing

Details: Benefit coverage for health services is determined by the member specific benefit plan document and applicable laws that may require coverage for a specific service. The do cumentation requirements outnli ed below are used to assess whether the member meets the clinci al criteria for coverage but do not guarantee coverage of the service requested.

› Verified 9 days ago

› Url: https://www.uhcprovider.com/content/dam/provider/docs/public/policies/comm-medical-drug/cell-free-fetal-dna-testing.pdf Go Now

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Ablative Treatment for Spinal Pain

Details: Benefit coverage for health services is determined by the member specific benefit plan document and applicable laws that may require coverage for a specific service. The documentation requirements outnli ed below are used to assess whether the member meets the clinci al criteria for co verage but do not guarantee coverage of the service requested.

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› Url: https://www.uhcprovider.com/content/dam/provider/docs/public/policies/comm-medical-drug/ablative-treatment-spinal-pain.pdf Go Now

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Testing and Cost Share Guidance UHCprovider.com

Details: UnitedHealthcare is updating testing guidelines, coding and reimbursement information for the COVID-19 health emergency, based on guidance from the Centers for Medicare & Medicaid Services (CMS), the Centers for Disease Control and Prevention (CDC), state and federal governments and other health agencies. Check back often for updates.

› Verified 5 days ago

› Url: https://www.uhcprovider.com/en/resource-library/news/Novel-Coronavirus-COVID-19/covid19-testing/covid19-testing-guidance.html Go Now

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Prolonged Services Policy, Professional

Details: qualified health care professional provides prolonged services beyond the usual service in either the inpatient or outpatient setting. Direct Patient Contact is face-to-face and includes additional non-face-to-face services on the patient’s floor or unit in the hospital or nursing facility during the same

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› Url: https://www.uhcprovider.com/content/dam/provider/docs/public/policies/comm-reimbursement/COMM-Prolonged-Services-Policy.pdf Go Now

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Outpatient Hospital Observation Policy, Facility

Details: This reimbursement policy applies to all health care services billed on UB04 forms. Coding methodology, industry-standard reimbursement logic, regulatory requirements, benefits design and other factors are considered in developing reimbursement policy. This information is intended to serve only as a general reference resource regarding

› Verified 5 days ago

› Url: https://www.uhcprovider.com/content/dam/provider/docs/public/policies/comm-reimbursement/COMM-Outpatient-Hospital-Observation-Policy-Facility.pdf Go Now

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Preferred Drug List (PDL)

Details: U.S.Dept. of Health and Human Services 200 Independence Avenue SW . Room 509F, HHH Building . Washington, D.C. 20201. If you need help withyour complaint,please call Member Services at. 1-800-348-4058, TTY 711. Services to help you communicatewithus areprovidedat no cost

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› Url: https://www.uhcprovider.com/content/dam/provider/docs/public/commplan/az/pharmacy/AZ-PDL-Complete-Care.pdf Go Now

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Neurophysiologic Testing and Monitoring

Details: Listing of a code in this policy does not imply that the service descrbi ed by the code is a covered or non -covered health service. Benefit coverage for health services is determine d by the member specific benefit plan document and applicable laws that may require coverage for a specific service.

› Verified 6 days ago

› Url: https://www.uhcprovider.com/content/dam/provider/docs/public/policies/comm-medical-drug/neurophysiologic-testing.pdf Go Now

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Delivering Home Health Services

Details: Delivering Home Health Services Frequently Asked Questions . PCA-1-20-01360-M&R-FAQ_06122020 . Overview . UnitedHealthcare is dedicated to providing innovative health and well-being solutions to help our Medicare Advantage members live healthier lives. One way we do that is by helping home health agencies

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› Url: https://www.uhcprovider.com/content/dam/provider/docs/public/health-plans/medicare/MA-Home-Health-Services-FAQ.pdf Go Now

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ERA Payer List for UnitedHealthcare, Affiliates and

Details: Sierra Health and Life ; 76342 CA, NV; UMR 39026; ALL UnitedHealthcare; 87726 ALL; UnitedHealthcare / All Savers Alternate Funding 81400; ALL UnitedHealthcare / All Savers Insurance; 81400 ALL; UnitedHealthcare / Oxford 06111; ALL UnitedHealthcare / UnitedHealthcare of the Mid-Atlantic, MD IPA, Optimum Choice and MAMSI Life and Health (formerly

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Durable Medical Equipment Reference List (NCD 280.1)

Details: guideline does not imply that the service described by the code is a covered or non-covered health service. Benefit coverage for health services is determined by the member specific benefit plan document and applicable laws that may require coverage for a specific service.

› Verified 8 days ago

› Url: https://www.uhcprovider.com/content/dam/provider/docs/public/policies/medadv-guidelines/d/durable-medical-equipment-dme-reference-list.pdf Go Now

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Prior Authorization Requirements for UnitedHealthcare

Details: Behavioral health services . Many of our benefit plans only provide coverage for behavioral health services through a designated behavioral health network. For specific codes requiring prior authorization, please call the number on the member’s health plan ID card to refer for mental health and substance abuse/substance services.

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› Url: https://www.uhcprovider.com/content/dam/provider/docs/public/prior-auth/pa-requirements/commercial/UHC-Commercial-Advance-Notification-Prior-Authorization-Requirements-3-1-2021.pdf Go Now

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10/2020: 2021 Telehealth Policy Updates UHCprovider.com

Details: 2021 Telehealth Policy Updates. With the rise of telehealth services, we want to help ensure improved access to services from providers and increased convenience for members. That’s why we’re modifying some of our UnitedHealthcare telehealth policies. Effective Jan. 1, 2021, certain UnitedHealthcare Medicare Advantage and commercial plans

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› Url: https://www.uhcprovider.com/en/resource-library/news/2020-network-bulletin-featured-articles/1020-telehealth-policy-updates.html Go Now

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2021 hospital policy changes: Notification updates for

Details: This change impacts UnitedHealthcare Medicare Advantage and UnitedHealthcare commercial health plans at this time. UnitedHealthcare Exchange plans, Dual Special Needs Plans and Community Plans (Medicaid) are currently out of scope for these notification requirements. Exceptions are noted below for UMR Health Plans and Neighborhood Health Plan

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Preventive Medicine and Screening Policy, Professional

Details: physicians and other qualified health care professionals, including, but not limited to, non-network authorized and percent of charge contract physicians and other qualified health care professionals. Policy Overview Preventive Medicine Services [Current Procedural Terminology (CPT®) codes 99381-99387, 99391-99397, Healthcare

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› Url: https://www.uhcprovider.com/content/dam/provider/docs/public/policies/medicaid-comm-plan-reimbursement/UHCCP-Preventive-Medicine-and-Screening-Policy-(R0013).pdf Go Now

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Paravertebral Facet Joint Injections

Details: Listing of a code in this guideline does not imply that the service described by the code is a covered or non-covered health service. Benefit coverage for health services is determined by the member specific benefit plan document and applicable laws that may require coverage for a specific service.

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Behavioral Health Services

Details: All behavioral health providers . Reimbursement for the Behavioral Health and Evaluation and Management CPT Codes are subject to the billing requirements established by the American Medical Association (AMA) and the American Psychiatric Association (APA). CPT codes (90832-90834, 90836-90839, 90875-90876, and 90899) are time-based.

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Telehealth Services UHCprovider.com

Details: UnitedHealthcare will reimburse appropriate claims for telehealth services in accordance with the member’s benefit plan. For certain markets and plans, UnitedHealthcare is continuing its expansion of telehealth access, including temporarily waiving the Centers for Medicare & Medicaid Services (CMS) originating site requirements.

› Verified 9 days ago

› Url: https://www.uhcprovider.com/content/provider/en/resource-library/news/Novel-Coronavirus-COVID-19/covid19-telehealth-services.html Go Now

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2021 Care Provider Manual

Details: Doc#: PCA-1-016630-03292021 v57.3.2021 2021 Care Provider Manual Physician, Health Care Professional, Facility and Ancillary UnitedHealthcare Community Plan of Kentucky

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Electrical Stimulation for the Treatment of Pain and

Details: Benefit coverage for health services is determined by the member specific benefit plan document and applicable laws that may require coverage for a specific service. The documentation requirements outnli ed below are used to assess whether the member meets the clinci al criteria for coverage but do not guarantee coverage of the service requested.

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› Url: https://www.uhcprovider.com/content/dam/provider/docs/public/policies/comm-medical-drug/electrical-stimulation-treatment-pain-muscle-rehabilitation.pdf Go Now

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Advance notification/prior authorization list

Details: The list of services that require advance notification and prior authorization is the same. The process for providing notification and submitting a prior authorization request is the same. Services that require prior authorization require a clinical coverage review based on medical necessity.

› Verified 5 days ago

› Url: https://www.uhcprovider.com/en/admin-guides/administrative-guides-manuals-2021/ch7-medical-management-2021/adv-not-prior-auth-list-ch7-guide.html Go Now

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UnitedHealthcare HouseCalls Program Overview

Details: UnitedHealthcare®. HouseCalls Collaborating with care providers to deliver valuable patient care HouseCalls is a yearly in-home assessment service available to eligible members of UnitedHealthcare Medicare Advantage plans,

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› Url: https://www.uhcprovider.com/content/dam/provider/docs/public/health-plans/HouseCalls-Program-Overview.pdf Go Now

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Home Health Services, Home Health Visits and Respite Care

Details: admitted to home health) or an allowed non-physician practitioner (NPP). Timeframe Requirements The encounter must occur no more than 90 days prior to the home health start of care date or within 30 days after the start of care. In situations when a physician orders home health care for the patient based on a new condition that was not evident

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Chromosome Microarray Testing (Non-Oncology Conditions)

Details: Benefit coverage for health services is determined by the member specific benefit plan document and applicable laws that may require coverage for a specific service. The documentation requirements outnli ed below are used to assess whether the member meets the clinci al criteria for coverage but do not guarantee coverage of the service requested.

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› Url: https://www.uhcprovider.com/content/dam/provider/docs/public/policies/comm-medical-drug/chromosome-microarray-testing.pdf Go Now

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UnitedHealthcare NexusACO

Details: Health plan coverage provided by UnitedHealthcare of Arizona, Inc., UHC of California DBA UnitedHealthcare of California, UnitedHealthcare Benefits Plan of Cali fornia, UnitedHealthcare of Colorado, Inc., UnitedHealthcare of the Mid-Atlantic, Inc., MAMSI Life and Health Insurance Company, UnitedHealthcare of New York, Inc.,

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M.D.IPA, M.D.IPA Preferred, Optimum Choice, and Optimum

Details: health benefit plans, and all network physicians and other health care professionals. • Members with M.D.IPA and Optimum Choice benefits must obtain a referral from their primary care physician (PCP) for most specialty services.

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› Url: https://www.uhcprovider.com/content/dam/provider/docs/public/health-plans/mid-atlantic/MIDATL-Referral-Protocol.pdf Go Now

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Rebundling Policy, Professional

Details: health services and supplies/home health agencies. For the purpose of this policy, the Same Individual Physician or Other Qualified Health Care Professional is the same individual rendering health care services reporting the same Federal Tax Identification number. Reimbursement Guidelines Edit …

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Preventive Medicine and Screening – Oxford …

Details: Listing of a code in this policy does not imply that the service described by the code is a covered or non- covered health service. Benefit coverage for health services is determined by the member specific benefit plan document and applicable laws that may require coverage for a specific service.

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Utah Health Plan Support Support by State

Details: Therapeutic Radiation Prior Authorization (IMRT, SRS, and SBRT) (For services to Medicare Advantage Customers only) Phone Number: 800-873-4575. What You Can Do When Calling this Number: Chiropractic, Physical Therapy, Occupational Therapy, and Speech Therapy Providers contracted with OptumHealth Physical Health, a UnitedHealth Group company.

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Ketalar (Ketamine) and Spravato (Esketamine)

Details: Listing of a code in this policy does not imply that the service described by the code is a covered or non-covered health service. Benefit coverage for health services is determined by the member specific benefit plan document and applicable laws that may require coverage for a specific service.

› Verified 8 days ago

› Url: https://www.uhcprovider.com/content/dam/provider/docs/public/policies/comm-medical-drug/ketalar-spravato.pdf Go Now

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Laboratory Services Policy, Professional

Details: health care services provided in a particular case. Further, the policy does not address all issues related to reimbursement for health care services provided to UnitedHealthcare Community Plan enrollees. Other factors affecting reimbursement supplement, modify or, in …

› Verified 7 days ago

› Url: https://www.uhcprovider.com/content/dam/provider/docs/public/policies/medicaid-comm-plan-reimbursement/UHCCP-Laboratory-Services-Policy-(R0014).pdf Go Now

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Cancer Therapy Pathways Program UHCprovider.com

Details: Health Plans Included. Members in a UnitedHealthcare commercial plan that currently requires prior authorization for chemotherapy and related cancer therapies, are eligible for rewards with the exception of the following health plans: 2. UnitedHealthcare commercial plans identified as Indemnity/Options PPO; UnitedHealthcare Oxford commercial plans

› Verified 9 days ago

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