Effective Jan. 1, 2021, you are required to send observation stay notifications and acute discharge notifications within 24 hours.
New Language to be included in the 2021 UnitedHealthcare Administrative Guide *
REQUIRED: Discharge notification: "We must receive the discharge notification from acute facilities within 24 hours after actual weekday discharge (or by 5 p.m. local time on the next business day if the 24-hour limit would require notification on a weekend or holiday). For weekend and holiday discharges, we must receive the notification by 5 p.m. local time on the next business day.”
REQUIRED: Observation stay notification: “Observation stay notifications are required to be submitted within 24 hours of patient no longer being held for observation (or by 5 p.m. local time on the next business day if the 24-hour limit would require notification on a weekend or holiday). For weekend and holiday admissions, we must receive the notification by 5 p.m. local time on the next business day.”
We prefer these notifications through automated channels, like 278N or ADT, the Prior Authorization and Notification tools in Link or phone.
To start using these automated channels you can:
There are currently no penalties associated with these new policy changes and claims will not be denied at this point. These requirements are being rolled out across Medicare Advantage and UnitedHealthcare commercial health plans at this time. Dual Special Needs Plans and Community Plans (Medicaid) are currently out of scope for these notification requirements.
Please contact your Provider Relations Representative, and for EDI submission setup support, visit the UnitedHealthcare Provider Technical Assistance page.
UPDATE: Our frequently asked questions for 2021 Hospital Policy Changes Notification Updates for Discharge and Observation Stays are now available for your review.
UPDATE: For Arkansas this requirement will not go into effect until Mar. 1, 2021.