UnitedHealthcare delays consultation services payment policy change UnitedHealthcare (UHC) announced in its October 2017 Network Bulletin that it will indefinitely delay changes to its consultation services payment policy, which would have discontinued reimbursement for CPT codes 99241-99245 and 99251-99255. Citing alignment with a policy implemented by the Centers for Medicare and Medicaid Services, and in response to misuse of consultation service codes, UHC had previously announced that it would no longer reimburse consultation services for commercial product lines effective October 1, 2017. In lieu of a consultation service code, physicians would have been required to bill utilizing ... October 19, 2017 General, Managed Care Consultation Codes, UnitedHealthcare 0 0 Comment Read More »
UnitedHealthcare to issue latest cycle of Peer Comparison Reports UnitedHealthcare (UHC) has announced that the next iteration of its Peer Comparison Reports will be sent to physicians beginning in November. The Peer Comparison Reports, formerly known as performance reports, contain analysis of a physician’s UHC paid claims data in comparison to nationally-based and risk-adjusted benchmarks. Only physicians whose paid claims data shows patterns that vary significantly from the identified benchmarks will receive a Peer Comparison Report. According to UHC, approximately 550 physicians in the following specialties will receive a Peer Comparison Report notification indicating that their paid claims data ... October 19, 2017 General, Managed Care UnitedHealthcare 0 0 Comment Read More »
Health plans begin transitioning patients from troubled Nivano The California Medical Association (CMA) has learned that two health plans—Blue Shield and UnitedHealthcare (UHC)—have recently terminated their delegated agreements with Nivano Physicians Medical Group and are in the process of transferring patients from Nivano to alternative networks. Nivano, also known as Northern California Physicians Medical Group with enrollees in Placer, Nevada, Sacramento, Yuba and Colusa counties, is currently on a corrective action plan with the Department of Managed Health Care (DMHC) for failure to meet financial solvency criteria. CMA has also received a surge of complaints about delays in ... August 9, 2017 Managed Care Blue Shield, UnitedHealthcare 0 0 Comment Read More »
UnitedHealthcare plans to discontinue payment for consultation services Citing alignment with a policy implemented by the Centers for Medicare and Medicaid Services (CMS), and in response to misuse of consultation service codes, UnitedHealthcare (UHC) has announced that it will no longer reimburse consultation services for commercial product lines effective October 1, 2017. Consultation services previously represented by CPT codes 99241-99245 and 99251-99255 will now need to be billed utilizing the appropriate evaluation and management (E/M) procedure code that describes the office visit, hospital care, nursing facility care, home service or domiciliary/rest home care. The California Medical Association (CMA), ... August 8, 2017 General Consultation Codes, UnitedHealthcare 0 0 Comment Read More »
Updated payor profiles for 2017 now available The California Medical Association’s (CMA) Center for Economic Services is publishing updated profiles on each of the major payors in California including Aetna, Anthem Blue Cross, Blue Shield of California, CIGNA, Health Net, UnitedHealthcare, Medicare/Noridian and Medi-Cal. Each profile includes key information on health plan market penetration; a description of the plan’s dispute resolution process; and the name and contact numbers for medical directors, provider relations, and other key contacts. Don’t waste your time searching the internet for this information – members can download CMA’s Payor Profiles free of charge ... August 1, 2017 CMA, Managed Care, Medi-Cal, Medicare Aetna, Anthem Blue Cross, Blue Shield, Cigna, Health Net, Insurance, Medi-Cal, Medicare, Noridian, Payor, Payor Profiles, Running a Practice, UnitedHealthcare 0 0 Comment Read More »
UnitedHealthcare to implement new drug testing reimbursement policy UnitedHealthcare has advised that it will implement a new drug testing reimbursement policy for commercial members effective for dates of service on or after September 1, 2017. The new policy will only allow one Presumptive Drug Class procedure per drug class (codes 80305, 80306 and 80307) per member, per date of service, whether submitted by the same or different provider. The policy will also only allow one Definitive Drug Class procedure per drug class (codes G0480, G0481, G0482, G0483 and G0659) per member, per date of service, whether submitted ... July 21, 2017 Managed Care Drug Testing, UnitedHealthcare 0 0 Comment Read More »
UnitedHealthcare requiring stricter notification requirements for out-of-network ASC referral UnitedHealthcare (UHC) recently issued a notification to approximately 80 California physicians reminding them that their participation agreement requires them to refer to in-network ambulatory surgical centers (ASC) for elective services. This notice comes on the heels of an August 2016 announcement that UHC will begin enforcing stricter notification requirements related to out-of-network ASC referrals. According to the UHC letter, physicians wishing to perform services at an out-of-network ASC will be required to notify UHC at least five days in advance of the procedure. Additionally, physicians will be expected to ... April 18, 2017 Managed Care Ambulatory Surgical Centers, ASC, UnitedHealthcare 0 0 Comment Read More »
