UnitedHealthcare (UHC) says it has made it easier for you to submit
records, have claims paid sooner, and access pharmacy benefit information.
Its new programs offer the following:
- Direct electronic
health record (EHR) system access: By downloading
clinical information straight from your EHR,
UHC will be able to collect the medical records it needs to process your claims
and conduct medical necessity and other reviews. The
company says this also will eliminate multiple requests for the same
- Clinical data exchange: You can share with UHC admit, discharge, and transfer data; discharge
summaries; and prescribed medication lists to help spot medication errors.
My Script: You can access real-time pharmacy benefit information like copays,
drug costs, and prior authorization requirements.
Find out more on the UHC
website. To use the EHR access
service, you’ll need to provide UHC medical record reviewers with access to
licenses and allow medical record download and storage in compliance with
HIPAA and other regulations. It also will be important to keep your medical
records up to date so UHC accesses current information.
More news about UHC
ACA plan records
request will require signature log: On behalf of UHC, Optum and CIOX Health will
request and review medical records from some practices Dec. 3 through March 15.
UHC will use the records to meet a federal requirement to report diagnostic
information about patients in some of its Affordable Care Act (ACA) health
plans. In addition to the records, practices also will be required to provide a
signature log for physicians, physician assistants, and nurse practitioners who
are mentioned in or have annotated medical records.
Site of care added to imaging medical necessity review: For dates of service on
or after Jan. 1, 2019, UHC will review the site of care for medical necessity
when you request prior authorization (PA) for advanced outpatient imaging
procedures, if the procedure will be performed in an outpatient setting (i.e.,
not in a free-standing diagnostic radiology center or an office setting).
Site-of-care reviews will apply the procedure
codes for which UHC currently requires notification/PA. Look for a
new policy, Magnetic Resonance Imaging and Computed Tomography — Site of Care,
to become available on UHC’s policies
need for any advanced outpatient imaging procedure rendered in an emergency
department, urgent care center, or observation unit, or during an inpatient
stay. For notification/PA, go to www.uhcprovider.com/radiology
or call (866) 889-8054.
Request peer-to-peer review via email: UHC has a new way to
initiate a peer-to-peer request for physicians who use the phone number (800)
955-7615 to contact UHC for this purpose: Submit the request by sending a
secure email through res.cisco.com/websafe to UHC_PeerToPeer_Scheduling[at]uhc[dot]com.
You also still can initiate a request by leaving a voicemail at the number
Bulletin, October 2018
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. Publishing this news or these excerpts
does not imply that TMA supports or approves of the changes announced or
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.