New UnitedHealthcare Automated Services Can Save You Time
By Ellen Terry

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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 information.
  • Clinical data exchange: You can share with UHC admit, discharge, and transfer data; discharge summaries; and prescribed medication lists to help spot medication errors.
  • PreCheck 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 plans:

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 page.

Notification/PA isn’t 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@uhc.com. You also still can initiate a request by leaving a voicemail at the number above.

Source: UHC Network 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 discussed.

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

November 13, 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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