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For those of you who haven't seen the announcement, united healthcare is implementing a diagnosis code requirement policy effective 5/1/2024 Resources for commercial, medicare advantage, community, and exchange plans. The following 3 existing policies will be retired effective 5/1/2024, because the content will be addressed in the new comprehensive policy:
Unitedhealthcare community plan may modify this reimbursement policy at any time by publishing a new version of the policy on this website Health care provider information about unitedhealthcare polices and protocols However, the information presented in this policy is accurate and current as of the date of publication.
This reimbursement policy is intended to ensure that you are reimbursed based on the procedure code or codes that correctly describe the health care services provided to individuals whose behavioral health benefits are administered by optum, including but not limited to unitedhealthcare members.
This information is intended to serve only as a general reference resource regarding unitedhealthcare community plan’s reimbursement policy for the services described and is not intended to address every aspect of a reimbursement situation. This white paper details these updates and provides guidance on how healthcare providers can comply with the new requirements to avoid claim denials. Unitedhealthcare medicare advantage reimbursement policy update bulletin March 2025 published reimbursement policies are intended to ensure reimbursement based on the code or codes that correctly describe the health care services provided.
Unitedhealthcare will roll out new reimbursement rules for routine lab tests beginning december 1, 2025, with phased state implementation and exclusions. Effective with dates of service may 1, 2024, united healthcare will introduce a comprehensive diagnosis could requirement policy for both professional and facility services. Review the latest unitedhealthcare prior authorization, medical policy, pharmacy, reimbursement, laboratory and policy and protocol updates
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