United Makes Changes to After-Hours Policies
By Ellen Terry

1.26 interstate billing

Here's some news you can use from UnitedHealthcare.

UnitedHealthcare (UHC) will accept an additional code under its After Hours and Weekend Care Policy. Effective Aug. 18, primary care physicians can report CPT code 99051 on UHC claims when billed with acute care services. Code 99051 denotes services provided in the office during regularly scheduled evening, weekend, or holiday office hours, in addition to basic service.

UHC’s current After Hours and Weekend Care Policy does not allow separate reporting of 99051; instead it is treated as a bundled code.

New Website for Premium Program

The UHC Premium program will have its own website in July. The Premium program recognizes doctors who meet certain quality and cost efficiency criteria. The website will have premium program methodology materials; a communication center for your program emails and notifications; and your designation, evaluation results, and access to your designation details. Registration instructions for the new site will be in your evaluation letter. You’ll need an Optum ID to validate your account, and all Premium program communications will be sent to your Optum ID email. If you have questions, call (866) 270-5588.Pharmacy

Source: UHC Network Bulletin, June 2018

More Tips From UHC

No NDC for immunization codes: For claims with a date of service on or after Sept. 1, the UHC National Drug Code (NDC) Requirement Policy will no longer require the NDC information for child and adult immunization drug codes. This change will apply to commercial and Medicare Advantage claims.

Don’t use defunct payer IDs: UHC has disabled discontinued payer IDs, and electronic claims submitted with the old IDs will be returned and marked “Invalid Payer ID.” See the complete UHC claims payer list to identify which plans you accept have new IDs and make the appropriate updates in your system to route claims from the former payer ID to the current one.

Source: UHC Network Bulletin, May 2018

Statins added to HEDIS measures: Two new Healthcare Effectiveness Data and Information Set (HEDIS) measures for 2018 are: 

 

  • Statin Therapy for Patients with Cardiovascular Disease
  • Statin Therapy for Patients with Diabetes 

 

For both measures, two rates are reported: patients who received the statin therapy, and patients who remained on the statin for at least 80 percent of the treatment period. For details, see UHC’s April 2018 Network Bulletin (page 17). These measures apply to UHC’s commercial, Community, and Medicare Advantage plans.

The Texas Medical Association’s payment specialists continuously review health care payment plans’ newsletters and updates for items important to Texas physicians. Texas Medicine Today periodically publishes key excerpts from those newsletters that you might have missed.

If you have questions about billing and coding or payer policies, contact the specialists at paymentadvocacy[at]texmed[dot]org for help, or call the TMA Knowledge Center at (800) 880-7955. TMA members can use the TMA Hassle Factor Log to help resolve insurance-related problems. Visit www.texmed.org/GetPaid for more resources and information.


Last Updated On

June 28, 2018

Originally Published On

June 28, 2018

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Ellen Terry

Project Manager, Client Services

(512) 370-1391

Ellen Terry has been writing, editing, and managing communication projects at TMA since 2000. She hails from Victoria, Texas; has a journalism degree from Texas State University; and loves to read great fiction. Ellen and her husband have two grown sons and a couple of cats.

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