Request UnitedHealthcare Peer-to-Peer Review Online
By Ellen Terry

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Here’s some news you might have missed that was published in UnitedHealthcare’s (UHC’s) Network Bulletin in December.  

New way to request peer-to-peer review: Seeking a peer-to-peer conversation after a preauthorization request was declined? Now you can request one through an online form available on UnitedHealthcare’s Prior Authorization and Notification webpage. 

Preferred Lab Network invitations: UnitedHealthcare has begun inviting freestanding medical laboratories that already participate in its networks to apply to join its Preferred Lab Network. To be accepted into the Preferred Lab Network, labs must meet access, cost, data, quality, and service criteria. UHC patients who use these labs may have lower out-of-pocket costs and shorter wait times than at UHC networks labs that don’t have preferred status. Labs must apply annually to be in the preferred network. UHC said it will provide more information about the program in summer 2020, along with the labs that will be included in the Preferred Lab Network. 

Email questions to UHC via preferred_lab@uhc.com

National drug code policy change: Effective for claims processed on and after March 1, 2020, UnitedHealthcare will add restrictions to its National Drug Code (NDC) Requirement Policy, Professional and Facility as it applies to its commercial and Medicare Advantage plans. 

The policy will limit specific drugs to the maximum units established for the NDC number submitted on the claim. Units above the maximum will be denied. UHC will enforce these quantities for drugs for which the package or kit is a specific dose and a set number of units is expected. 

The policy will not apply to drugs that vary in dosage per NDC or for which the dose is based on a patient’s weight/body surface area such that the entire unit of a single package or kit could be exceeded appropriately. 

Have you looked at your peer comparison report? Last month, UnitedHealthcare mailed select specialty physicians a letter directing them to the Document Vault on its portal. The report shows how a physician’s practice compares with other physicians in the UHC network. It also identifies areas in which the physician is doing well and where there may be room for improvement, with suggested actions.

Only physicians meeting select criteria are eligible for a peer comparison report. If you believe a report is available to you, you can access it in the Document Vault via Link by signing in with your Optum ID. 

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@texmed.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

January 02, 2020

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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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