February 10, 2022

Observation notifications are no longer required for most plans

As of Dec. 1, 2021, for most plans, providers are no longer required to submit observation notification after a patient has been discharged home from observation level of care. You can use our Prior Authorization and Notification tool on the UnitedHealthcare Provider Portal to determine if a plan requires notification of a member admitting to observation level of care.

Background
From Jan. 1, 2021, through Nov. 30, 2021, observation notifications were required to be submitted within 24 hours of a 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). These notifications enabled engagement with members in a timely manner to help ensure members were connected to resources that support their care after an observation stay.

Why is this change being made?
While there is still a need to engage members to help ensure they are connected to resources that support their care following an observation stay, we are looking to other data sources for this information.

Notification of outpatient surgery and other outpatient services with observation
For members expected to be in observation following outpatient surgery or other outpatient services, use our Prior Authorization and Notification tool for notification requirements of the specific outpatient surgical procedure or outpatient service being rendered.

Questions?
Please contact your provider relations representative for assistance. For electronic data interchange (EDI) submission setup support, visit the UnitedHealthcare Provider Technical Assistance page.

PCA-22-00175-PO-News