You spoke, we listened. You told us it would be helpful to learn about upcoming policy changes that may affect the claims you submit. In response, UnitedHealthcare is implementing Informational Smart Edits messages. These messages provide you with the opportunity to find out about new policies being implemented in the future.
CSP — Consultation Code (Informational Alert Only)
- UnitedHealthcare is revising the Consultation Services Policy and will no longer reimburse CPT® codes 99241-99255. This change aligns UnitedHealthcare with the Centers for Medicare & Medicaid Services (CMS). We would like to partner with care providers on older fee schedules (2009 and prior) to move to more current fee schedules.
You can find out more information about this policy in the March Network Bulletin.
umAT/umONP — Always Therapy (Informational Alert Only)
- Effective with dates of service on or after July 1, 2019, the GN, GO or GP modifiers will be required on “Always Therapy” codes to align with CMS.
- According to CMS, certain codes are “Always Therapy” services, regardless of who performs them, and always require a therapy modifier (GP, GO or GN) to indicate they’re provided under a physical therapy, occupational therapy or speech-language pathology plan of care.
You can find out more information about this policy in the April Network Bulletin
Speeding Up Claims, Together
UnitedHealthcare has been using an EDI edit solution called Smart Edits, which identifies claims with potential errors before they are processed. Reviewing the Smart Edits messages that appear on the 277CA clearinghouse report and resubmitting with the suggested revisions will reduce claim error rates, denials and resubmissions and help improve claims processing time. Care providers who submit professional claims electronically to Payer ID 87726 should receive Smart Edits.
Stay In the Know
Since the November 2018 Network Bulletin announcement, several smart edit releases have been deployed for UnitedHealthcare Medicare Advantage, UnitedHealthcare Community Plan and UnitedHealthcare commercial plans. You can stay up to date on all active edits and resources by visiting UHCprovider.com/smartedits.
Care providers with an active Link profile can visit the UHC On-air Smart Edits training page for a refresher on Smart Edits and also in-depth, edit-specific training at UHCprovider.com.
For more information about the Smart Edit logic, contact the EDI Support Team at SupportEDI@uhc.com or call 800-842-1109