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Long-awaited and highly anticipated, providers hope other payers will follow suit. Healthcare insurer giant UnitedHealthcare (UHC) has announced that it will be suspending prior authorization requirements for post-acute settings through May 31, 2020, with the waiver applying to long-term care facilities (LTCFs), acute inpatient rehabilitation (AIR), and skilled nursing facilities…
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The saga of increased scrutiny of Medicare Advantage plans continues to unfold. UnitedHealthcare’s SuspensionCMS announced a suspension of one year for the UnitedHealthcare H5322 contract for not reaching the mandatory 85percent medical loss ratio (MLR). Plans must achieve that magic medical loss ratio on an annual basis. For those unfamiliar…
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Plan was “strongly opposed” by NY healthcare groups. The Healthcare Association of New York (HANY) told providers Tuesday that the Empire State that it will not use the UnitedHealthcare (UHC) Sepsis-3 criteria when reviewing claims to validate sepsis for payment. New York state law defines sepsis with systemic inflammatory response…
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The UHC sepsis definition raises new audit concerns. Each month, UnitedHealthcare (UHC) keeps providers appraised about its policy changes with an online bulletin. These bulletins contain important information about pre-authorization requirements, changes to preferred providers, new fax numbers, and much more. In most cases, I read through it and find…
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Expect denials as the healthcare giant is cracking down on Levels 4 and Level 5 UnitedHealthcare (UHC) will reportedly review and possibly adjust or deny facility emergency department (ED) claims submitted with Level 4 and Level 5 evaluation and management (E&M) codes, with facilities able to submit reconsideration or appeal…
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Proprietary algorithm to determine “correct” code and change claim. It’s clearly a new age in the coding of emergency department (ED) visits – after all, one insurance giant is reportedly looking to take the human element out of the equation completely. ED facility coding and auditing seems to be a…