Volume III - 2015

In This Issue:

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HEDIS Data Collection for UHC Community Plan

UnitedHealthcare Community Plan is required to collect Healthcare Effectiveness Data and Information Set (HEDIS) information annually from participating care providers.

Those offices that accept UHC Community Plan must provide requested medical record information to comply with the Centers for Medicare & Medicaid Services (CMS), state and federal regulators and accreditation organization requirements.  HEDIS data collection takes place between February and May.

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Submitting Provider Updates and Changes to Summa Health Network

This is just a friendly reminder that submitting changes for provider offices in a prompt and timely fashion will ensure that payers have the most updated information.

These updates include any of the following:

  • Phone number
  • Fax number
  • Email address
  • Physical address
  • Any other provider changes

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ICD-10 Update

Recently, the Centers for Medicare & Medicaid Services (CMS) talked with providers to identify common misperceptions about the transition to ICD-10.

Here are five facts that address some of the common questions and concerns CMS has heard about ICD-10...

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Molina Healthcare Claim Reconsideration Policy Update

Molina Healthcare has extended their provider submission timeframe from 14 days to 30 days for the Medicaid line of business.

The updated policy will apply to all pre-service prior authorization and post-service claim requests for reconsideration received April 1, 2015 and after.

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UnitedHealthcare's Updated Vaccine Reimbursement Policy

UnitedHealthcare recently updated their policy on reimbursement for vaccinations for Community Plan members.

Through this policy, UHCP will ensure compliance with the federally mandated Vaccines For Children program, while reducing inappropriate payments where providers have access to free vaccines for children enrolled in Medicaid, and also meet all State specific requirements.

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Humana Policy Change Regarding Anatomical Modifiers

On April 28, 2015, Humana implemented a new claims policy requiring the use of anatomical modifiers when appropriate.

This information is a part of our larger provider education initiative, and is available to providers on the provider portal at humana.com/HealthcareProviderHowTo.

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Prior Authorization Required by UHCP for Nasal Endoscopy Procedures

Effective June 1, 2015, the following UnitedHealthcare Community Plans will require prior authorization for nasal sinus endoscopy procedures for patients 12 years and older who have to have one of more of the following medical treatments: nasal lavage, antibiotics and/or corticosteroids.

Failure to complete the prior authorization process will result in an administrative claim denial. Members cannot be billed for claims that are administratively denied.

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