11/06/2018

Managed Care Committee Reimbursement TIDBITS

Featuring this month: United Healthcare

TidBits thanks to 

MSHO Managed Care Committee Member

SHELBY JENSEN 

Did you know... UHC is retiring fax numbers used for Medical Prior Authorization requests. The fax numbers retiring on 01/01/2019 are:

877-269-1045
866-362-6101
866-892-4582
866-589-4848
866-255-0959

More numbers will be added to the list over the next several months. UHC will let everyone know which numbers are being retired in the Network Bulletin and at UHCprovider.com .

Did you know... Eff: 02/01/2019, Optum, an affiliate company of UHC, will begin managing the prior authorization requests for outpatient injectable chemotherapy and related cancer therapies:

• The change applies to UHC Commercial members with a cancer diagnosis. Any active prior authorizations requested through the former process will remain in place.

To submit an online request for prior auth through the new process, sign in to LINK and access the Prior Authorization and Notification tool. Then select the “Radiology, Cardiology + Oncology” box. After answering 2 short questions about the state you are in, you’ll be directed to a new website to process the authorization.
 
*****Prior auths for UHC Oxford and Medicare members will CONTINUE to go through eviCore until further notice.*****

Did you know... BILLING ISSUE FOR INTRAVENOUS AND SUBCUTANEOUS IMMUNE GLOBULIN AND REMICADE:

UHC has received claims related to UHC commercial plans and UHC Community Plan without the appropriate ICD-10 diagnosis code as listed in the UHC Medical Benefit Drug policy guidelines. The billing issue for IV and SC (subcutaneous) IVIG and Remicade affecting outpatient facilities. Claims will be reviewed to ensure the condition treated with these drugs is consistent with the Medical Benefit Drug Policy. If a claim denial or line denial occurs for this reason, a rep from Optum will contact the care provider to review the claim. The service must have correct criteria as outlined in the UHC Medical Benefit Drug policy.

Visit their Website at...https://www.uhcprovider.com 

NOTE: A different Michigan Payer will be featured monthly.

 Visit the MSHO Website for a listing of the Michigan Health Plans and the MSHO Managed Care Committee.

CLICK HERE