DECEMBER 2017 network bulletin - UnitedHealthcare Online · For on-demand videos, go to the UHC On...

network bulletinAn important message from UnitedHealthcare to health care professionals and facilities.

DECEMBER 2017

Enter

UnitedHealthcare respects the expertise of the physicians, health care professionals and their staff who participate in our network. Our goal is to support you and your patients in making the most informed decisions regarding the choice of quality and cost-effective care, and to support practice staff with a simple and predictable administrative experience. The Network Bulletin was developed to share important updates regarding UnitedHealthcare procedure and policy changes, as well as other useful administrative and clinical information.

Where information in this bulletin conflicts with applicable state and/or federal law, UnitedHealthcare follows such applicable federal and/or state law.

UnitedHealthcare Network Bulletin December 2017

2 | For more information, call 877-842-3210 or visit UHCprovider.com.

Table of ContentsFront & CenterStay up to date with the latest news and information.

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UnitedHealthcare CommercialLearn about program revisions and requirement updates.

PAGE 17

UnitedHealthcare Community PlanLearn about Medicaid coverage changes and updates.

PAGE 23

UnitedHealthcare Medicare AdvantageLearn about Medicare policy and guideline changes.

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UnitedHealthcare AffiliatesLearn about updates with our company partners.

PAGE 32

State NewsStay up to date with the latest state/regional news.

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UnitedHealthcare Network Bulletin December 2017 Table of Contents


Front & CenterStay up to date with the latest news and information.

Introducing the New Network BulletinBased on your feedback, we’ve made some changes to the Network Bulletin. Finding the information you need is now faster and easier!

Tell Us What You Think of Our CommunicationsPlease take a few minutes to complete an online survey and give us your thoughts about the Network Bulletin and UnitedHealthcare Communications.

Link Self-Service Updates and Enhancements plus UHCWest.com RetirementWe’re making enhancements to Link and retiring UHCWest.com.

Update to Notification/Prior Authorization Requirements – Effective Jan. 1, 2018Beginning Jan. 1, 2018, notification/prior authorization will no longer be required for an abdominal paracentesis procedure for UnitedHealthcare Commercial plans, except for some of our affiliate plans.

Changes in Advance Notification and Prior Authorization RequirementsAs of Oct. 1, 2017, continuous airway pressure (CPAP) device code E0601 no longer requires prior authorization.

Review at Launch Drug Program for UnitedHealthcare Commercial and Community Plan Members – Effective Jan. 1, 2018As a reminder, please consider requesting pre-service coverage review for medications listed on UnitedHealthcare’s Review at Launch Commercial or Community Plan Medication List.

Pharmacy Update – Notice of Changes to Prior Authorization Requirements and Coverage Criteria for UnitedHealthcare Commercial and OxfordA Pharmacy Bulletin outlining upcoming new or revised clinical programs and implementation dates is now available online for UnitedHealthcare Commercial.

Revised and New Emergency Department (ED) Facility Evaluation and Management (E/M) Coding Policies – Effective March 1, 2018UnitedHealthcare will revise the current Emergency Department (ED) Facility Evaluation and Management (E/M) Coding Reimbursement Policy for UnitedHealthcare Commercial Plans and adopt new policies for UnitedHealthcare Medicare Advantage plans, as well as UnitedHealthcare Community Plans in select states.



Front & CenterStay up to date with the latest news and information.

Refresher: Referral Submission versus Notification and Prior Authorization SubmissionWhen submitted online, both notification and prior authorization requests should be submitted through the Notification and Prior Authorization app on Link. Referral submissions are separate and currently the online tool varies with the member’s plan.

Dental Clinical Policy & Coverage Guideline Updates

UnitedHealthcare Community Plan Launches a Dual Special Needs Program – UnitedHealthcare Dual CompleteEffective Jan. 1, 2018, UnitedHealthcare Community Plan will begin to serve eligible members in a new Dual Special Needs Plan (DSNP) – “UnitedHealthcare Dual Complete Medicare Advantage” – in several states. *Impacted states: Iowa, Michigan, Missouri, Nebraska, North Carolina, Oklahoma and Virginia.



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Introducing the New Network BulletinYou spoke and we listened! UnitedHealthcare conducted online surveys to determine how we could enhance the Network Bulletin and improve your experience with it.

We met with focus groups of care provider practices over the past several months to hear what they wanted in the Network Bulletin. Then, we incorporated these suggestions and online survey results to redesign the Bulletin.

Here are some of the new features being launched in this December issue:• Easier navigation so you can find what you’re looking for quickly and easily

• Summaries of articles in each section so you can read brief descriptions, allowing you to know quickly which articles pertain to you and your practice

• Sections by line of business, state and specialty so you can easily find what applies to you

• Links to policy summaries so you can quickly navigate to the information you need

Tell Us What You Think of Our CommunicationsAs a regular reader of The Network Bulletin, your opinion is important to us. We’d like to get your thoughts about The Bulletin and UnitedHealthcare communications related to network changes, quality initiatives and other issues. Please take a few minutes today to complete the survey online at uhcresearch.az1.qualtrics.com/jfe/form/ SV_08sAsRnUY2Kb153. Thank you for your time.



Link Self-Service Updates and Enhancements plus UHCWest.com RetirementLink is the gateway to the online self-service tools for UnitedHealthcare. We’re continuously making improvements to Link apps to support your workflows. Here are some recent enhancements we’ve made:

• New search option in the claimsLink app availableon a limited basisA new search option has been added for physiciansand groups that have fewer than 450 claims per day.Small and medium claim volume groups can nowsearch for paid and denied claims by date and taxidentification number (TIN) without a specific memberID. If your search parameters would return more than450 claims, you will see a message suggesting thatyou reduce the date range.

• Reports added to Document Vault– All reports from UnitedHealthcareOnline.com

have been moved to the Document Vault on Link.This includes capitation, claim recovery, earlypreventative screenings diagnostic tests (EPSDT)for Medicaid, hospital monitoring, PCP panel roster,preventive health measures and stars scorecards.

– Capitation, eligibility and patient managementreports from UHCWest.com will also be moved toDocument Vault soon. Please refer to Informationfor UHCWest.com Users for the latest information.

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The UHCWest.com website will be retiring soon and will redirect you to UHCprovider.com, our new care provider website. The News and Network Bulletin page has the latest news on the UHCWest.com retirement and applications. Certain care providers will also receive notices by mail, where required by state law.

To access Link apps, go to UHCprovider.com and use the Link button in the upper right corner to sign in with your Optum ID. Information on all available apps is available at UHCprovider.com/Link. We offer several live webinar options — information and registration is available at UHCprovider.com/training. For on-demand videos, go to the UHC On Air app on your Link dashboard and select the UHC News Now channel and then Link and Provider Self-Service.

An Optum ID is required to access Link and perform online transactions, such as eligibility verification, claims status, claims reconsideration, referrals, prior authorizations and more. To get an Optum ID, go to UHCprovider.com and click on New User to register for Link access.

For help with Link, call the UnitedHealthcare Connectivity Helpdesk at 866-842-3278, option 1, Monday through Friday, 8 a.m. to 10 p.m. Eastern Time.



Update to Notification/Prior Authorization Requirements – Effective Jan. 1, 2018As we continue to evaluate notification/prior authorization requirements, we’re making some changes. Effective for dates of service on or after Jan. 1, 2018, notification/prior authorization will no longer be required for the following abdominal paracentesis procedure for UnitedHealthcare Commercial plans, except for some of our affiliate plans. UnitedHealthcare Oxford will continue to require notification/prior authorization for these procedures.

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CPT® Code Procedure49083 Abdominal paracentesis (diagnostic or therapeutic); with imaging guidance

This change also applies to prior authorization requirements we previously communicated for UnitedHealthcare Community Plan members in these states:• Arizona

• Delaware

• Maryland

• New Mexico

• New York

• Pennsylvania

• Rhode Island

• Tennessee

• Washington

For more details about notification/prior authorization requirements, go to UHCprovider.com/priorauth.



Changes in Advance Notification and Prior Authorization Requirements

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As of Oct. 1, 2017, continuous airway pressure (CPAP) device code E0601 no longer requires prior authorization for all plans: UnitedHealthcare Commercial Plans (UnitedHealthcare Mid Atlantic Health Plan, Navigate, Neighborhood Health Partnership, UnitedHealthOne, UnitedHealthcare Commercial, UnitedHealthcare of the River Valley and UnitedHealthcare West), UnitedHealthcare Community Plans, and UnitedHealthcare Medicare Plans (UnitedHealthcare Medicare Advantage, UnitedHealthcare West, UnitedHealthcare Community Dual Special Needs Plans, UnitedHealthcare Community Plan Massachusetts Senior Care Options, UnitedHealthcare Connected – TX (Medicare-Medicaid Plan), UnitedHealthcare Connected for MyCareOhio (Medicare-Medicaid Plan), UnitedHealthcare Community Plans-Medicare and Medica and Preferred Care of Florida health plan).

Prior authorization is not required for the three-month rental of the continuous airway pressure (CPAP) device. This device will be approved without a prior authorization. Purchases of the CPAP device will be denied, per contract.

Code Replacements to Prior AuthorizationEffective for dates of service on or after Jan. 1, 2018, new ventricular assist device codes will be added to prior authorization as a result of the American Medical Association (AMA) 2018 annual update to the Current Procedure Terminology for all plans: UnitedHealthcare Commercial Plans (UnitedHealthcare Mid Atlantic Health Plan, Navigate, Neighborhood Health Partnership, UnitedHealthOne, UnitedHealthcare Commercial, UnitedHealthcare of the River Valley and UnitedHealthcare West), UnitedHealthcare Community Plans, and UnitedHealthcare Medicare Plans (UnitedHealthcare Medicare Advantage, UnitedHealthcare West, UnitedHealthcare Community Dual Special Needs Plans, UnitedHealthcare Community Plan Massachusetts Senior Care Options, UnitedHealthcare Connected- TX (Medicare-Medicaid Plan), UnitedHealthcare Connected for MyCareOhio (Medicare-Medicaid Plan), UnitedHealthcare Community Plans-Medicare and Medica and Preferred Care of Florida health plan).

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Category Deleted Codes Replacement Codes Added to Prior AuthorizationVentricular Assist Device 0051T 33927

0052T 33928

0053T 33929

Effective for dates of service on or after Jan. 1, 2018, new codes will be added to prior authorization as a result of the American Medical Association (AMA) 2018 annual update to the Current Procedure Terminology for UnitedHealthcare Commercial Plans

(UnitedHealthcare Mid Atlantic Health Plan, Navigate, Neighborhood Health Partnership, UnitedHealthOne, UnitedHealthcare Commercial, UnitedHealthcare Oxford, and UnitedHealthcare of the River Valley).

Category Deleted Codes Replacement Codes Added to Prior AuthorizationInjectable Medications (Hemophilia)

Replacing use of unclassified codes

J7210, J7211



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Code Removals from Existing Prior Authorization Categories Beginning Jan. 1, 2018, certain codes under the following categories will no longer require prior authorization for many plans. The updated prior authorization requirements will be available in the Prior Authorization lists posted to UHCprovider.com and UHCCommunityPlan.com in late December 2017. These categories are not being removed (unless noted below), only specific codes within them.

This change is part of UnitedHealthcare’s ongoing efforts to align our medical policies, clinical programs and health benefits with the latest scientific evidence and specialty society guidance. Using evidence to guide coverage decisions supports quality patient care and reflects our shared commitment to the Triple Aim of better care, better health outcomes and lower costs.

Although prior authorization requirements are being removed for certain codes, post-service determinations may still be applicable based on criteria published in medical policies and/or local and national coverage determination criteria.

UnitedHealthcare Commercial Plans: UnitedHealthcare Mid Atlantic Health Plan, Navigate, UnitedHealthOne, UnitedHealthcare Commercial and UnitedHealthcare Commercial West. The prior authorization reduction does not apply to Neighborhood Health Partnership, UnitedHealthcare of the River Valley and UnitedHealthcare Oxford health plans.

• Bone Growth Stimulator

• Durable Medical Equipment

• Orthotics/Prosthetics

• Potentially Unproven (to include Continuous Glucose Monitors)

• Some hysterectomy codes will only require prior authorization when billed with gender dysphoria treatment diagnosis codes

UnitedHealthcare Community Plans: For the UnitedHealthcare Community Plan Massachusetts Senior Care Options, UnitedHealthcare Connected – TX (Medicare-Medicaid Plan), and the UnitedHealthcare Connected for MyCareOhio (Medicare-Medicaid Plan), refer to the UnitedHealthcare Medicare Plans section.

• Acupuncture (applicable to MD CAID, NJ CAID/LTC)

• Allergent Immunotherapy (applicable to KS CAID/CHIP/LTC)

• Bone Growth Stimulator

• Cosmetic & Reconstructive

• Durable Medical Equipment

• Experimental & Investigational (to include Continuous Glucose Monitors)

• Gender Dysphoria Treatment (applicable to TN CAID/LTC)

• Home Health Care Services

• Hysterectomy (applicable to TN CAID/LTC)

• Incontinence Supplies

• Outpatient Therapy

• Orthotics/Prosthetics

• Sleep Apnea (applicable to MS CAN/CHIP)

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UnitedHealthcare Medicare Plans: UnitedHealthcare Medicare Advantage, UnitedHealthcare West, UnitedHealthcare Community Dual Special Needs Plans, UnitedHealthcare Community Plan Massachusetts Senior Care Options, UnitedHealthcare Connected- TX (Medicare-Medicaid Plan), UnitedHealthcare Connected for MyCareOhio (Medicare-Medicaid Plan), and UnitedHealthcare Community Plans-Medicare. The prior authorization reduction does not apply to the Medica and Preferred Care of Florida health plan.

• Cardiology – Echocardiograms

• Home Health Care Services

• Proton Beam Therapy (entire category removal)

• Radiology – CT and MRI/MRA

• Vagus Nerve (entire category removal)

• Vein Procedures

The most up-to-date Advance Notification lists are available online:

• UnitedHealthcare Medicare and UnitedHealthcare Commercial Plans – UHCprovider.com/priorauth > Advance Notification and Plan Requirement Resources > Plan Requirement Resources

• UnitedHealthcare Community Plan – UHCCommunityPlan.com > For Health Care Professionals > Select your state.

If you have questions about a prior authorization requirement for a member, please contact UnitedHealthcare using the phone number on the back of the member’s ID card.



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Review at Launch Drug Program for UnitedHealthcare Commercial and Community Plan Members – Effective Jan. 1, 2018As a reminder, please consider requesting pre-service coverage review for medications listed on UnitedHealthcare’s Review at Launch Commercial or Community Plan Medication List. We’ll add certain new drugs to the Review at Launch list and policy after they’re approved by the Food and Drug Administration. Drugs will remain on the list until we communicate otherwise.

For medications on the list, we encourage you to request pre-service coverage reviews so you know whether a medication is covered before providing services. Some benefit plans may not cover certain medications under the medical benefit. Clinical coverage reviews can also help avoid starting a patient on therapy that may later be denied due to lack of medical necessity. Your claims may be denied if a pre-service coverage review is not completed.

If you have any questions, call the Provider Services number on the member’s ID card.

Pharmacy Update — Notice of Changes to Prior Authorization Requirements and Coverage Criteria for UnitedHealthcare Commercial and OxfordA Pharmacy Bulletin outlining upcoming new or revised clinical programs and implementation dates is now available online for UnitedHealthcare Commercial. Go to UHCprovider.com/pharmacy.



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• The revised policy for UnitedHealthcare Commercial plans will apply to claims with dates of service on or after March 1, 2018.

• The ED Facility E/M Coding Reimbursement Policies for UnitedHealthcare Medicare Advantage plans and select UnitedHealthcare Community Plans will also be effective for dates of service on or after March 1, 2018.

• For information related to reimbursement policies for UnitedHealthcare Community Plans in specific states, please go to UHCCommunityPlan.com > For Health Care Professionals > Select Your State.

These enhancements support UnitedHealthcare’s commitment to the Triple Aim of improving health care services, health outcomes and overall cost of care.

These policies focus on facility ED claims that are submitted with level 4 (99284, G0383) and level 5 (99285, G0384) E/M codes. These policies were developed using our national experience to address inconsistencies in coding accuracy and were based on the E/M coding principles created by the Centers for Medicare & Medicaid Services (CMS) that require hospital ED facility E/M coding guidelines to follow the intent of CPT® code descriptions and reasonably relate to hospitals resource use.

These policies will apply to all facilities, including freestanding facilities, that submit ED claims with level 4 and 5 E/M codes for members of the affected plans, regardless of whether they’re under contract to participate in our network.

As part of the implementation of these policies, we’ll begin using the Optum Emergency Department Claim (EDC) Analyzer tool, which determines appropriate E/M coding levels based on data such as the patient’s presenting problem, diagnostic services performed during the visit and associated patient co-morbidities. To learn more about the EDC Analyzer tool, please visit EDCAnalyzer.com.

Facilities submitting claims for ED E/M codes may experience adjustments to level 4 or 5 E/M codes to reflect an appropriate level E/M code or may receive a denial, based on the reimbursement structure within their agreements with UnitedHealthcare.

Facilities submitting claims for ED E/M codes may experience adjustments to level 4 or 5 E/M codes to reflect an appropriate level E/M code or may receive a denial, based on the reimbursement structure within their agreements with UnitedHealthcare. Facilities will have the opportunity to submit reconsideration or appeal requests if they believe a higher level E/M code is justified, in accordance with the terms of their contract and/or Administrative Guide.

Revised and New Emergency Department (ED) Facility Evaluation and Management (E/M) Coding Policies – Effective March 1, 2018As part of our continued efforts to reinforce accurate coding practices, UnitedHealthcare will revise the current Emergency Department (ED) Facility Evaluation and Management (E/M) Coding Reimbursement Policy for UnitedHealthcare Commercial Plans and adopt new policies for UnitedHealthcare Medicare Advantage plans, as well as UnitedHealthcare Community Plans in select states.

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Criteria that may exclude outpatient facility claims from these policies include, but are not limited to:

• Admissions from the emergency department

• Critical care patients

• The patient is less than 2 years old

• Claims with certain diagnosis that when treated in the ED most often necessitate greater than average resource usage, such as significant nursing time

• Patients who have expired in the emergency department

• Claims from facilities whose billing of level 4 and 5 E/M codes does not abnormally deviate from the EDC Analyzer tool determination.

If you need further information, please contact your Network Representative or call Provider Services at 877-842-3210. Thank You.

Revised and New Emergency Department (ED) Facility Evaluation and Management (E/M) Coding Policies – Effective March 1, 2018

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Refresher: Referral Submission versus Notification and Prior Authorization SubmissionWhat is a referral and how does it compare to notification and prior authorization? For benefit plans with referral requirements, the member’s assigned Primary Care Provider (PCP) coordinates the member’s care and submits electronic referrals to us before the member sees another network physician.

Advance notification and prior authorization are part of the UnitedHealthcare Medical Management Program:

• Advance notification is the first step in the coverage determination process and for recommending case and condition management programs.

• When prior authorization is required, it allows us to verify whether the services are medically necessary, covered under the member’s benefit plan and performed at the most appropriate setting for the member.

Submitting referral, notification and prior authorization requests via EDIWhen using electronic data interchange (EDI), the 278N Hospital Admission Notification transaction is used for notifications and the 278 Authorization and Referral Request transaction is used for both referrals and prior authorization requests, even though they are quite different.

Online submission of referral, notification and prior authorization requestsWhen submitted online, both notification and prior authorization requests should be submitted through the Notification and Prior Authorization app on Link. Referral submissions are separate and the online tool varies with the member’s plan.

We’re working toward a single online app for all referrals. In the meantime, the easiest way to determine the correct online submission method is to look up the member in eligibilityLink. You’ll see whether a referral is required and you can click on the “Referrals” link to open the correct submission tool.

For help with Link, call the UnitedHealthcare Connectivity help desk at 866-842-3278, option 1, Monday through Friday 8 a.m. to 10 p.m. Eastern Time.

PATIENT NAME



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Dental Clinical Policy & Coverage Guideline UpdatesFor complete details on the policy updates listed in the following table, please refer to the November 2017 UnitedHealthcare Dental Policy Update Bulletin at UHCprovider.com > Menu > Policies and Protocols > Dental Clinical Policies and Coverage Guidelines > Dental Policy Update Bulletins.

Policy Title Policy Type Effective Date

UPDATED/REVISED

Bacterial and Viral Testing Coverage Guideline Nov. 1, 2017Labial Veneers Coverage Guideline Nov. 1, 2017Non-Surgical Periodontal Therapy Clinical Policy Dec. 1, 2017Space Maintenance Coverage Guideline Nov. 1, 2017Surgical Extraction of Erupted Teeth and Retained Roots Coverage Guideline Nov. 1, 2017Surgical Extraction of Impacted Teeth Clinical Policy Dec. 1, 2017Therapeutic Parenteral Drug Administration and In-Office Dispensing of Medications

Clinical Policy Nov. 1, 2017

Note: The inclusion of a dental service (e.g., procedure or technology) on this list does not imply that UnitedHealthcare provides coverage for the dental service. In the event of an inconsistency or conflict between the information in this bulletin and the posted policy, the provisions of the posted policy prevail.



UnitedHealthcare Community Plan Launches a Dual Special Needs Program – UnitedHealthcare Dual Complete

UnitedHealthcare Community Plan

On Jan. 1, 2018, UnitedHealthcare Community Plan will begin to serve eligible members in a new Dual Special Needs Plan (DSNP) – UnitedHealthcare Dual Complete, a Medicare Advantage plan – in the following seven states and counties:

• Iowa – Dallas, Jasper, Madison, Marshall, Polk, Story, Warren

• Michigan – Berrien, Branch, Gratiot, Hillsdale, Tuscola, Washtenaw

• Missouri – Boone, Buchanan, Callaway, Cass, Christian, Clay, Cole, Crawford, Dade, Dallas, DeKalb, Franklin, Gasconade, Greene, Jackson, Jasper, Jefferson, Johnson, Laclede, Lafayette, Lawrence, Lincoln, Miller, Newton, Osage, Platte, Polk, Ray, St. Charles, St. Francois, St. Louis, St. Louis City, Ste. Genevieve, Stone, Taney, Warren, Washington, Webster, Wright

• Nebraska – Cass, Douglas, Lancaster, Sarpy

• North Carolina – statewide

• Oklahoma – Canadian, Cleveland, Kingfisher, Lincoln, Logan, McClain, Oklahoma, Pottawatomie

• Virginia – statewide

We communicated details of this new plan in the October Network Bulletin.

This is a Medicare Advantage plan for members who qualify for both Medicare and Medicaid. DSNPs are a specialized type of Medicare Advantage Prescription Drug Plan (MAPD) and must follow existing Centers for Medicare & Medicaid Services (CMS) rules.

The UnitedHealthcare Dual Complete program will reimburse claims, according to your UnitedHealthcare contractual Medicare Advantage payment appendix. Please visit UHCCommunityPlan.com > For Health Care Professionals > Select your state > Dual Complete Program.

For more information about this program, please contact your network account manager or advocate.



UnitedHealthcare CommercialLearn about program revisions and requirement updates.

Medical Record Review – ACA-Covered Commercial Plans for 2017 Dates of ServiceWe may be requesting medical records from you to comply with an Affordable Care Act requirement from Dec. 4, 2017 through March 16, 2018.

Harken Health Individual Plans Ending Dec. 31, 2017Harken Health will not be offering individual benefit plans in 2018.

Laboratory Benefit Management Program Pilot Update

UnitedHealthcare will be making changes to the program pilot beginning March 1, 2018.

UnitedHealthcare Medical Policy, Medical Benefit Drug Policy and Coverage Determination Guideline Updates



UnitedHealthcare Commercial

Medical Record Review – ACA-Covered Commercial Plans for 2017 Dates of Service We’re required by the Department of Health & Human Services (HHS), under the Affordable Care Act (ACA), to submit complete diagnostic information about members enrolled in certain Commercial ACA-covered health plans. This means we may be requesting medical records from you to comply with this requirement from Dec. 4, 2017 through March 16, 2018.

We provided details on these medical record reviews in the October Network Bulletin.

If you’re selected for a medical record review, we will ask you to provide information for 2017 dates of service for a certain number of your patients. To reduce the potential for administrative burden on your office, we use the records received through this request for other appropriate health care operations, for example, monitoring compliance with HEDIS© measures.

What You Will Need to DoAll requested medical records and documentation will need to be completed March 16, 2018 to meet the HHS deadline for these record requests. This is unlike Medicare record requests you may have had in the past, as we need to adhere to a tighter window with one retrieval wave for our UnitedHealthcare Commercial members.

If you have any questions about the scheduling of the medical record review:

• Call CIOX Health at 877-445-9293, between 7 a.m. to 8 p.m., Central Time, Monday through Friday

• Email [email protected]

mailto:chartreview%40cioxhealth.com?subject=




Harken Health Individual Plans Ending Dec. 31, 2017All Harken Health individual benefit plans will end on Dec. 31, 2017, and Harken will not offer individual benefit plans in 2018. Harken Health will continue to pay claims for services provided in 2017 as a part of your UnitedHealthcare Participation Agreement for individual benefit plan members.

Some Harken Health Group Plans Continue in 2018There may still be Harken Health group members who will have benefit plans that continue into 2018, but the membership will be small. Harken will continue to pay claims for group benefit plan members that are still eligible through the end of their benefit plan year. To check benefits and eligibility for group plan members in 2018, call a membership assistant at 800-797-9921.

What This Means to YouPlease continue seeing individual and group Harken Health members through Dec. 31, 2017 or whenever their coverage ends. We’ll continue to support your delivery of care and claims payment as long as members are eligible.

If you have any questions on benefits, eligibility or claims status, call a membership assistant at 800-797-9921.




Laboratory Benefit Management Program Pilot UpdateUnitedHealthcare’s Laboratory Benefit Management Program pilot, which went live on April 15, 2015, is designed to help improve quality and support appropriate utilization of lab services, while controlling costs through the use of network laboratories. Based on feedback from care providers and evaluation of pilot results, UnitedHealthcare will make changes to the program pilot on March 1, 2018.

These changes are intended to improve the care provider experience:

• A revised Decision Support Test List

• Accommodations for CLIA and referring physician claim submission requirements for physician offices

• New decision support features

• Additional electronic health record/laboratory ordering system integrations

• Various Physician Decision Support platform design improvements

The Laboratory Benefit Management Program only applies to laboratory services for fully insured UnitedHealthcare Commercial members in Florida, excluding Neighborhood Health Partnership. Please make sure you follow all applicable program requirements for these members to avoid claims impact.

To view the updated Laboratory Benefit Management Program Administrative Guide, the Decision Support Test List and other resources, visit UHCprovider.com > Menu > Policies and Protocols > Lab Benefit Management Program Information.

Beacon Laboratory Benefit Solutions, Inc. (BeaconLBS®), which specializes in laboratory services management, administers the Laboratory Benefit Management Program. If you’re not registered with BeaconLBS, visit BeaconLBS.com and select Login.

Contact your UnitedHealthcare Provider Advocate or network manager if you have questions or feedback as you implement the program in your practice.




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UnitedHealthcare Medical Policy, Medical Benefit Drug Policy and Coverage Determination Guideline UpdatesFor complete details on the policy updates listed in the following table, please refer to the November 2017 Medical Policy Update Bulletin at UHCprovider.com > Menu > Policies and Protocols > Commercial Policies > Commercial Medical & Drug Policies and Coverage Determination Guidelines > Medical Policy Update Bulletins.


NEW

Alpha1-Proteinase Inhibitors Drug Feb. 1, 2018

Ilaris® (Canakinumab) Drug Jan. 1, 2018

Review at Launch for New to Market Medications Drug Jan. 1, 2018

UPDATED/REVISED

Actemra® (Tocilizumab) Injection for Intravenous Infusion Drug Dec. 1, 2017

Ambulance Services CDG Nov. 1, 2017

Attended Polysomnography for Evaluation of Sleep Disorders Medical Dec. 1, 2017

Blepharoplasty, Blepharoptosis and Brow Ptosis Repair CDG Dec. 1, 2017

Breast Reconstruction Post Mastectomy CDG Dec. 1, 2017

Breast Repair/Reconstruction Not Following Mastectomy CDG Dec. 1, 2017

Cardiovascular Disease Risk Tests Medical Jan. 1, 2018

Durable Medical Equipment, Orthotics, Ostomy Supplies, Medical Supplies and Repairs/Replacements CDG Jan. 1, 2018

Electric Tumor Treatment Field Therapy Medical Nov. 1, 2017

Emergency Health Care Services and Urgent Care Center Services CDG Nov. 1, 2017

Enzyme Replacement Therapy Drug Dec. 1, 2017

Epiduroscopy, Epidural Lysis of Adhesions and Functional Anesthetic Discography Medical Jan. 1, 2018





Exondys 51™ (Eteplirsen) Drug Dec. 1, 2017

Habilitative Services for Essential Health Groups CDG Jan. 1, 2018

Hip Resurfacing and Replacement Surgery (Arthroplasty) Medical Dec. 1, 2017

Panniculectomy and Body Contouring Procedures CDG Nov. 1, 2017

Pectus Deformity Repair CDG Nov. 1, 2017

Preventive Care Services CDG Dec. 1, 2017

Preventive Care Services CDG Jan. 1, 2018

Probuphine® (Buprenorphine) Drug Dec. 1, 2017

Rehabilitation Services (Outpatient) CDG Jan. 1, 2018

Respiratory Interleukins (Cinqair® and Nucala®) Drug Dec. 1, 2017

Rhinoplasty and Other Nasal Surgeries CDG Nov. 1, 2017

Site of Service Guidelines for Certain Outpatient Surgical Procedures URG Jan. 1, 2018

Specialty Medication Administration – Site of Care Review Guidelines URG Jan. 1, 2018

Vagus Nerve Stimulation Medical Jan. 1, 2018

Xolair® (Omalizumab) Drug Dec. 1, 2017

RETIRED/REPLACED

Hip Replacement Surgery (Arthroplasty) Medical Dec. 1, 2017

Lyme Disease Medical Nov. 1, 2017

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UnitedHealthcare Medical Policy, Medical Benefit Drug Policy and Coverage Determination Guideline Updates

Note: The inclusion of a health service (e.g., test, drug, device or procedure) on this list does not imply that UnitedHealthcare provides coverage for the health service. In the event of an inconsistency or conflict between the information in this bulletin and the posted policy, the provisions of the posted policy prevail.



UnitedHealthcare Community PlanLearn about Medicaid coverage changes and updates.

UnitedHealthcare Community Plan Medical Policy, Medical Benefit Drug Policy and Coverage Determination Guideline Updates




UnitedHealthcare Community Plan Medical Policy, Medical Benefit Drug Policy and Coverage Determination Guideline UpdatesFor complete details on the policy updates listed in the following table, please refer to the November 2017 Medical Policy Update Bulletin at UHCprovider.com > Menu > Policies and Protocols > Community Plan Policies > Medical & Drug Policies and Coverage Determination Guidelines > Medical Policy Update Bulletins.


NEW

Alpha1-Proteinase Inhibitors Drug Feb. 1, 2018

Exondys 51™ (Eteplirsen) (for Pennsylvania Only) Drug Jan. 1, 2018

Ilaris® (Canakinumab) Drug Feb. 1, 2018

Pharmacogenetic Testing Medical Dec. 1, 2017

Review at Launch for New to Market Medications Drug Jan. 1, 2018

Whole Exome and Whole Genome Sequencing Medical Dec. 1, 2017

UPDATED/REVISED

Actemra® (Tocilizumab) Injection for Intravenous Infusion Drug Jan. 1, 2018

Ambulance Services CDG Jan. 1, 2018

Attended Polysomnography for Evaluation of Sleep Disorders Medical Dec. 1, 2017

Attended Polysomnography for Evaluation of Sleep Disorders Medical Jan. 1, 2018

Bariatric Surgery Medical Dec. 1, 2017

Blepharoplasty, Blepharoptosis and Brow Ptosis Repair CDG Dec. 1, 2017

Breast Reconstruction Post Mastectomy CDG Jan. 1, 2018

Breast Repair/Reconstruction Not Following Mastectomy CDG Jan. 1, 2018

Cardiovascular Disease Risk Tests Medical Jan. 1, 2018

Durable Medical Equipment, Orthotics, Ostomy Supplies, Medical Supplies and Repairs/Replacements CDG Jan. 1, 2018

Electric Tumor Treatment Field Therapy Medical Nov. 1, 2017

Emergency Health Care Services and Urgent Care Center Services (Maryland Only) CDG Jan. 1, 2018

Enzyme Replacement Therapy Drug Jan. 1, 2018

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Epiduroscopy, Epidural Lysis of Adhesions and Functional Anesthetic Discography Medical Jan. 1, 2018

Functional Endoscopic Sinus Surgery (FESS) Medical Jan. 1, 2018

Gonadotropin Releasing Hormone Analogs Drug Dec. 1, 2017

Hereditary Angioedema (HAE), Treatment and Prophylaxis Drug Dec. 1, 2017

Hip Resurfacing and Replacement Surgery (Arthroplasty) Medical Jan. 1, 2018

Infliximab (Remicade®, Inflectra™, Renflexis™) Drug Dec. 1, 2017

Minimally Invasive Procedures for Gastroesophageal Reflux Disease (GERD)

Medical Dec. 1, 2017

Neurophysiologic Testing and Monitoring Medical Dec. 1, 2017

Omnibus Codes Medical Dec. 1, 2017

Oncology Medication Clinical Coverage Drug Dec. 1, 2017

Orencia® (Abatacept) Injection for Intravenous Infusion Drug Dec. 1, 2017

Panniculectomy and Body Contouring Procedures CDG Nov. 1, 2017

Pectus Deformity Repair CDG Nov. 1, 2017

Preterm Labor Management Medical Dec. 1, 2017

Probuphine® (Buprenorphine) Drug Jan. 1, 2018

Respiratory Interleukins (Cinqair® and Nucala®) Drug Dec. 1, 2017

Rhinoplasty and Other Nasal Surgeries CDG Nov. 1, 2017

Site of Service Guidelines for Certain Outpatient Surgical Procedures URG Jan. 1, 2018

Vagus Nerve Stimulation Medical Jan. 1, 2018

Xolair® (Omalizumab) Drug Dec. 1, 2017

RETIRED/REPLACED

Hip Replacement Surgery (Arthroplasty) Medical Jan. 1, 2018

Lyme Disease Medical Nov. 1, 2017



UnitedHealthcare Community Plan Medical Policy, Medical Benefit Drug Policy and Coverage Determination Guideline Updates

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UnitedHealthcare Medicare AdvantageLearn about Medicare policy and guideline changes.

Collecting the Correct Cost Share in an Outpatient Clinic SettingStarting Jan. 1, 2018, additional controls will be added to assess the correct cost sharing to outpatient clinic claims for UnitedHealthcare Medicare Advantage members.

Outpatient Injectable Chemotherapy Notification for UnitedHealthcare Medicare Advantage Plans: Florida and GeorgiaOn March 1, 2018, notification will be required for injectable outpatient chemotherapy drugs given for a cancer diagnosis for UnitedHealthcare Medicare Advantage health plan members in Florida and Georgia.

UnitedHealthcare Medicare Advantage Coverage Summary Updates

UnitedHealthcare Medicare Advantage Policy Guideline Updates



UnitedHealthcare Medicare Advantage

Collecting the Correct Cost Share in an Outpatient SettingIn reviewing past UnitedHealthcare Medicare Advantage claims, we found inconsistencies with how member cost shares were collected when an office visit occurred in an outpatient clinic setting. For some outpatient clinic visits, UnitedHealthcare Medicare Advantage members were charged for a primary care provider (PCP) office visit when they saw a specialist or they were not charged at all.

Starting Jan. 1, 2018, additional controls will be added to assess the correct cost sharing to outpatient clinic claims for UnitedHealthcare Medicare Advantage members. Care providers should make sure they collect the correct cost share for services provided. Member notifications will be sent by early December 2017. We won’t reprocess any claims due to this issue.

Please contact Provider Services or your Provider Advocate if you have any questions.



Outpatient Injectable Chemotherapy Notification for UnitedHealthcare Medicare Advantage Plans: Florida and GeorgiaOn March 1, 2018, notification will be required for injectable outpatient chemotherapy drugs given for a cancer diagnosis for UnitedHealthcare Medicare Advantage health plan members in Florida and Georgia, including AARP MedicareComplete, Care Improvement Plus, UnitedHealthcare Dual Complete® and UnitedHealthcare Group Medicare plans. This is part of our effort to continually improve health care experiences, outcomes and total cost of care for our members. We have contracted with eviCore to provide a web-based application to review chemotherapy regimens.


Notification will be required for:• Chemotherapy injectable drugs (J9000 - J9999),

Leucovorin (J0640) and Levoleucovorin (J0641)

• Chemotherapy injectable drugs that have a Q code

• Chemotherapy injectable drugs that haven’t received an assigned code and will be billed under a miscellaneous Healthcare Common Procedure Coding System (HCPCS) code

• All outpatient injectable chemotherapy drugs and growth factors started after the notification effective date

• Adding a new injectable chemotherapy drug or growth factor to a regimen

Notification will not be required for:• Radio-therapeutic agents (e.g., Zevalin and Xofigo)

• Oral chemotherapy drugs, which are covered under a member’s pharmacy benefit plan

• Growth factors including: J2505 (neulasta), J1442, (neupogen), J2820 Leukine® (sargramostim), Q5101, (Filgrastim–biosimilar Zarxio), J1447 Granix (tbofilgrastim)

• Use of chemotherapy drugs for non-cancer diagnosis

How to Submit NotificationTo submit an online notification request for injectable chemotherapy, go to UHCprovider.com.

• Sign in to Link by clicking on the Link button in the top right corner of UHCprovider.com. Use your Optum ID and select the Prior Authorization and Notification app.

• If you don’t have an Optum ID, click the New User button in the top right corner of UHCprovider.com.

Please complete all notifications online. If you have questions or need assistance with your online request, call 866-889-8054, 7 a.m. to 7 p.m., Monday through Friday.




UnitedHealthcare Medicare Advantage Coverage Summary UpdatesFor complete details on the policy updates listed in the following table, please refer to the November 2017 Medicare Advantage Coverage Summary Update Bulletin at UHCprovider.com > Menu > Policies and Protocols > Medicare Advantage Policies > Coverage Summaries > Coverage Summary Update Bulletins.

Policy Title

UPDATED/REVISED (Approved on Oct. 17, 2017)

Abortion

Alcohol, Chemical and/or Substance Abuse: Detoxification and Rehabilitation

Blood, Blood Products and Related Procedures and Drugs

Cardiac Pacemakers and Defibrillators

Change in Membership Status while Hospitalized (Acute, LTC and SNF) or Receiving Home Health

Chelation Therapy

Chemotherapy, and Associated Drugs and Treatments

Court, Attorney or Agency Requested Services

Durable Medical Equipment (DME), Prosthetics, Corrective Appliances/Orthotics (Non-Foot Orthotics) and Medical Supplies Grid

Emergent/Urgent Services, Post-Stabilization Care and Out-of-Area Services

Medications/Drugs (Outpatient/Part B)

Pain Management and Pain Rehabilitation

Prostate: Services and Procedures

Uterine Services and Procedures

Ventricular Assist Device (VAD) and Artificial Heart

REPLACED (Approved on Oct. 17, 2017)

Diagnostic Pap Smear





UnitedHealthcare Medicare Advantage Policy Guideline UpdatesThe following UnitedHealthcare Medicare Advantage Policy Guidelines have been updated to reflect the most current clinical coverage rules and guidelines developed by the Centers for Medicare & Medicaid Services (CMS). The updated policies are available for your reference at UHCprovider.com > Menu > Policies and Protocols > Medicare Advantage Policies > Policy Guidelines.

Policy Title

NEW (Approved on Oct. 11, 2017)

Spinal Cord Stimulators for Chronic Pain

Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD)

UPDATED/REVISED (Approved on Oct. 11, 2017)

Abarelix for the Treatment of Prostate Cancer (NCD 110.19)

Ambulatory Blood Pressure Monitoring (NCD 20.19)

Ambulatory EEG Monitoring (NCD 160.22)

Anzemet for Chemotherapy Induced Nausea

Aprepitant for Chemotherapy-Induced Emesis (NCD 110.18)

Cardiac Output Monitoring by Thoracic Electrical Bioimpedance (TEB) (NCD 20.16)

Cardiac Rehabilitation Programs for Chronic Heart Failure (NCD 20.10.1)

Certain Drugs Distributed by the National Cancer Institute (NCD 110.2)

Chemical Aversion Therapy for Treatment of Alcoholism (NCD 130.3)

Colorectal Cancer Screening Tests (NCD 210.3)

Coverage of Drugs and Biologicals for Label and Off-Label Uses

Diagnostic Pap Smears (NCD 190.2)

Dimethyl Sulfoxide (DMSO) (NCD 230.12)

Electrical Aversion Therapy for Treatment of Alcoholism (NCD 130.4)

Granulocyte Transfusions (NCD 110.5)

Hyperthermia for Treatment of Cancer (NCD 110.1)

Inpatient Hospital Stays for Treatment of Alcoholism (NCD 130.1)

CONTINUED >




UnitedHealthcare Medicare Advantage Policy Guideline Updates

Policy Title

Interferon

Laetrile and Related Substances (NCD 30.7)

L-Dopa (NCD 160.17)

Nonselective (Random) Transfusions and Living Related Donor Specific Transfusions (DST) in Kidney Transplantation (NCD 110.16)

Outpatient Hospital Services for Treatment of Alcoholism (NCD 130.2)

Podiatry

Retinal Prosthesis

Screening Pap Smears and Pelvic Examinations for Early Detection of Cervical or Vaginal Cancer (NCD 210.2)

Self-Administered Drug(s) (SAD)

Surgical or Other Invasive Procedure Performed on the Wrong Body Part (NCD 140.7)

Surgical or Other Invasive Procedure Performed on the Wrong Patient (NCD 140.8)

Treatment of Alcoholism and Drug Abuse in a Freestanding Clinic (NCD 130.5)

Treatment of Drug Abuse (Chemical Dependency) (NCD 130.6)

Treatment of Psoriasis (NCD 250.1)

Ventricular Assist Devices (NCD 20.9.1)

Withdrawal Treatments for Narcotic Addictions (NCD 130.7)

Wrong Surgical or Other Invasive Procedure Performed on a Patient (NCD 140.6)

RETIRED (Approved on Oct. 11, 2017)

Smoking and Tobacco-Use Cessation Counseling (NCD 210.4)


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UnitedHealthcare AffiliatesLearn about updates with our company partners.

Oxford® Medical and Administrative Policy Updates

SignatureValue/UnitedHealthcare Benefits Plan of California Medical Management Guideline Updates

SignatureValue/UnitedHealthcare Benefits Plan of California Benefit Interpretation Policy Updates




NEW

Acupuncture Reimbursement Feb. 1, 2018

Alpha1-Proteinase Inhibitors Clinical Feb. 1, 2018

Ilaris® (Canakinumab) Clinical Jan. 1, 2018

Review at Launch for New to Market Medications Clinical Jan. 1, 2018

UPDATED/REVISED

Accreditation Requirements for Radiology Services Administrative Dec. 1, 2017

Actemra® (Tocilizumab) Injection for Intravenous Infusion Clinical Dec. 1, 2017

Attended Polysomnography for Evaluation of Sleep Disorders Clinical Dec. 1, 2017

Autologous Chondrocyte Transplantation in the Knee Clinical Nov. 1, 2017

Bariatric Surgery Clinical Dec. 1, 2017

Bilateral Procedures Reimbursement Nov. 1, 2017

Blepharoplasty, Blepharoptosis and Brow Ptosis Repair Clinical Dec. 1, 2017

Breast Imaging for Screening and Diagnosing Cancer Clinical Dec. 1, 2017

Cardiology Procedures Requiring Precertification for eviCore healthcare Arrangement

Clinical Dec. 1, 2017

Drug Coverage Criteria - New and Therapeutic Equivalent Medications Clinical Dec. 1, 2017

Drug Coverage Guidelines Clinical Dec. 1, 2017

Exondys 51™ (Eteplirsen) Clinical Dec. 1, 2017

Extended Benefits for Total Disability & Succeeding Carrier for Inpatient Admissions

Administrative Dec. 1, 2017

From - To Date Policy Reimbursement Nov. 1, 2017

Maximum Frequency Per Day Reimbursement Nov. 20, 2017

Microsurgery Reimbursement Nov. 1, 2017

UnitedHealthcare Affiliates

Oxford® Medical and Administrative Policy UpdatesFor complete details on the policy updates listed in the following table, please refer to the November 2017 Policy Update Bulletin at OxfordHealth.com > Providers > Tools & Resources > Medical Information > Medical and Administrative Policies > Policy Update Bulletin.

CONTINUED >




Minimally Invasive Procedures for Gastroesophageal Reflux Disease (GERD) Clinical Dec. 1, 2017

Modifier Reference Reimbursement Nov. 1, 2017

Neurophysiologic Testing and Monitoring Clinical Dec. 1, 2017

New Patient Visit Reimbursement Nov. 1, 2017

Newborns Administrative Dec. 1, 2017

Obstetrical Ultrasonography Clinical Dec. 1, 2017

Omnibus Codes Clinical Dec. 1, 2017

Oxford's Outpatient Imaging Self-Referral Clinical Nov. 1, 2017

Oxford's Outpatient Imaging Self-Referral Clinical Dec. 1, 2017

Pediatric and Neonatal Critical and Intensive Care Services Reimbursement Nov. 1, 2017

Percutaneous Vertebroplasty and Kyphoplasty Clinical Nov. 1, 2017

Precertification Exemptions for Outpatient Services Administrative Dec. 1, 2017

Preterm Labor Management Clinical Dec. 1, 2017

Preventive Care Services Clinical Oct. 11, 2017

Preventive Care Services Clinical Dec. 1, 2017

Preventive Care Services Clinical Jan. 1, 2018

Probuphine® (Buprenorphine) Clinical Dec. 1, 2017

Radiation Therapy Procedures Requiring Precertification for eviCore healthcare Arrangement


Radiology Procedures Requiring Precertification for eviCore healthcare Arrangement


Reduced Services Reimbursement Nov. 1, 2017

Respiratory Interleukins (Cinqair® and Nucala®) Clinical Dec. 1, 2017

Robotic Assisted Surgery Reimbursement Nov. 1, 2017

Sensory Integration Therapy and Auditory Integration Training Clinical Nov. 1, 2017

Urgent Care Reimbursement Dec. 1, 2017

Virtual Upper Gastrointestinal Endoscopy Clinical Nov. 1, 2017

Visual Information Processing Evaluation and Orthoptic and Vision Therapy Clinical Nov. 1, 2017


CONTINUED >

< CONTINUED





Warming Therapy and Ultrasound Therapy for Wounds Clinical Nov. 1, 2017

Xolair® (Omalizumab) Clinical Dec. 1, 2017



< CONTINUED

Note: The inclusion of a health service (e.g., test, drug, device or procedure) on this list does not imply that Oxford provides coverage for the health service. In the event of an inconsistency or conflict between the information in this bulletin and the posted policy, the provisions of the posted policy prevail.

Oxford HMO products are underwritten by Oxford Health Plans (NY), Inc., Oxford Health Plans (NJ), Inc. and Oxford Health Plans (CT), Inc. Oxford insurance products are underwritten by Oxford Health Insurance, Inc.




Policy Title Effective Date

UPDATED/REVISED

Attended Polysomnography for Evaluation of Sleep Disorders Dec. 1, 2017

Blepharoplasty, Blepharoptosis and Brow Ptosis Repair Dec. 1, 2017

Cardiovascular Disease Risk Tests Jan. 1, 2018

Electric Tumor Treatment Field Therapy Nov. 1, 2017

Epiduroscopy, Epidural Lysis of Adhesions and Functional Anesthetic Discography Jan. 1, 2018

Hip Resurfacing and Replacement Surgery (Arthroplasty) Dec. 1, 2017

Hospital Readmissions Dec. 1, 2017

Pectus Deformity Repair Nov. 1, 2017

Preventive Care Services Oct. 11, 2017

Preventive Care Services Dec. 1, 2017

Preventive Care Services Jan. 1, 2018

Rhinoplasty and Other Nasal Surgeries Nov. 1, 2017

Vagus Nerve Stimulation Jan. 1, 2018

RETIRED/REPLACED

Hip Replacement Surgery (Arthroplasty) Dec. 1, 2017

Lyme Disease Nov. 1, 2017

SignatureValue/UnitedHealthcare Benefits Plan of California Medical Management Guideline UpdatesFor complete details on the policy updates listed in the following table, please refer to the November 2017 SignatureValue/UnitedHealthcare Benefits Plan of California Medical Management Guidelines Update Bulletin at UHCprovider.com > Menu > Policies and Protocols > Commercial Policies > UnitedHealthcare SignatureValue/ UnitedHealthcare Benefits Plan of California Medical Management Guidelines > Medical Management Guideline Update Bulletins.





SignatureValue/UnitedHealthcare Benefits Plan of California Benefit Interpretation Policy UpdatesFor complete details on the policy updates listed in the following table, please refer to the November 2017 SignatureValue/UnitedHealthcare Benefits Plan of California Benefit Interpretation Policy Update Bulletin at UHCprovider.com > Menu > Policies and Protocols > Commercial Policies > UnitedHealthcare SignatureValue/UnitedHealthcare Benefits Plan of California Benefit Interpretation Policies > Benefit Interpretation Policy Update Bulletins.

Policy Title Applicable State(s) Effective Date

UPDATED/REVISED

ChemotherapyAll (California, Oklahoma, Oregon, Texas, & Washington)

Dec. 1, 2017

Dental Care and Oral Surgery All Dec. 1, 2017

Diagnostic and Therapeutic Radiology Services All Dec. 1, 2017

Enteral and Oral Nutritional Therapy All Dec. 1, 2017

Inpatient and Outpatient Mental Health All Dec. 1, 2017

Maternity and Newborn Care All Dec. 1, 2017

Parenteral Nutrition Therapy All Nov. 1, 2017

Telemedicine/Telehealth Services/Virtual Visits All Dec. 1, 2017




State NewsLearn about updates with our company partners.

Outpatient Injectable Chemotherapy Notification for UnitedHealthcare Medicare Advantage Plans: Florida and GeorgiaOn March 1, 2018, notification will be required for injectable outpatient chemotherapy drugs given for a cancer diagnosis for UnitedHealthcare Medicare Advantage health plan members in Florida and Georgia.

Appointment Standards for the State of ConnecticutThe State of Connecticut established standards for appointment access and after-hours care.



State News

Type of Service Standard

Urgent care Within 48 hours of the member contacting the care provider

Non-urgent appointments for primary care Within 10 business days of the member contacting the care provider

Non-urgent appointments for specialist care Within 15 business days of the member contacting the care provider

Non-urgent for non-physical mental health Within 10 business days of the member contacting the care provider

Non-urgent for ancillary services Within 15 business days of the member contacting the care provider

Appointment Standards for the State of ConnecticutUnitedHealthcare’s network care providers play an essential role in helping ensure members have appropriate access to primary, urgent, preventive and specialty care.

To help ensure timely member access to care, the State of Connecticut requires compliance with the following appointment standards:

PCA-1-008646-11032017_11102017

This protocol is available at UHCprovider.com > Menu> Policies and Protocols > Protocols > Appointment-Standards for the State of Connecticut.

Insurance coverage provided by or through UnitedHealthcare Insurance Company, All Savers Insurance Company or its affiliates. Health plan coverage provided by UnitedHealthcare of Arizona, Inc., UHC of California DBA UnitedHealthcare of California, UnitedHealthcare of Colorado, Inc., UnitedHealthcare of Oklahoma, Inc., UnitedHealthcare of Oregon, Inc., UnitedHealthcare of Texas, Inc., UnitedHealthcare Benefits of Texas, Inc., UnitedHealthcare of Utah, Inc. and UnitedHealthcare of Washington, Inc. or other affiliates. Administrative services provided by United HealthCare Services, Inc. OptumRx, OptumHealth Care Solutions, Inc. or its affiliates. Behavioral health products are provided by U.S. Behavioral Health Plan, California (USBHPC), United Behavioral Health (UBH) or its affiliates.

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