COVID-19 billing, temporary provision and vaccine updates
UnitedHealthcare has revised the COVID-19 Billing Guide to reflect additional guidance for urgent care testing, vaccine-related services, monoclonal antibody treatments and more. We’ve also updated the Summary of COVID-19 Temporary Program Provisions with information on COVID-19 treatment cost share waivers.
To help your conversations with members about COVID-19 vaccines, we’ve created a new Building COVID-19 Vaccine Confidence self-paced learning course with tips and scenarios to help you respond during conversations with members.
Last update: February 3, 2021, 12:48 p.m. CT
The information and self-service tools on this page will help you manage your practice administration responsibilities during the COVID-19 national public health emergency period. Please check back often, as any changes or interruptions to standard UnitedHealthcare business practices, processes and policies will be updated here.
For easy reference, this Summary of COVID-19 Dates outlines the beginning and end dates of program, process and procedure changes that UnitedHealthcare has implemented as a result of COVID-19.
To all health care professionals who are caring for sick patients and working around the clock to help find solutions – thank you for all you’re doing. You’re important to us. That’s why we’re gathering resources and support for health care professionals from across UnitedHealth Group to help you focus on, manage and understand your mental and physical well-being during the national public health emergency.
The podcast hosts also provide strategies for managing both current and long-term mental health needs resulting from the national public health emergency that health care professionals can use to support themselves and their patients.
Understanding and Managing the Effects of COVID-19 on Mental Health:
If you’d like to view supplemental material or register to receive CE credits for completing the training activity, visit OptumHealth Education.
We’re also supporting the organizations and charities that help support you and your colleagues. You can read more about that in our News Releases.
On April 7, 2020, UnitedHealth Group announced that it would accelerate payments and provide other financial support to assist providers in UnitedHealthcare’s Medicare Advantage, Medicaid, and Individual and Group Market fully insured health plans.
For claims submitted on or after April 7, providers may receive payment anywhere from a few days to two weeks earlier than usual. Other financial support currently includes the provision for up to $125 million in small business loans to clinical operators with whom OptumHealth is partnered.
UnitedHealthcare has carefully reviewed its incentive programs and accelerated payments where possible. The incentive payment accelerations may take the form of an additional interim payment; if that happens, a final performance measurement and incentive settlement will still need to take place. If incentive payments are accelerated, these payments could occur as early as mid-April.
Please follow the existing standard billing guidelines for using the CR and DR modifier codes. There has not been any updated guidance issued by the Centers for Medicare and Medicaid Services (CMS), federal, state or other officials regarding the use of, and accompanying reimbursement for, the CR and DR modifier codes. We are monitoring CMS guidance and federal and state laws and will make adjustments accordingly.
The Testing, Treatment, Coding and Reimbursement section has detailed information about COVID-19-related claims and billing, including detailed coding and billing guidelines. The telehealth services coding guide also shows examples of how services might be reimbursed.
During the national public health emergency period, Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) can bill for telehealth services using the 95 modifier through June 30, 2020.
Beginning July 1, 2020 through Oct. 22, 2020, the Centers for Medicare & Medicaid Services (CMS) is requiring FQHCs and RHCs bill for telehealth services using code G2025, with the 95 modifier optional. This applies to all UnitedHealthcare Medicare Advantage benefit plan members.
For UnitedHealthcare Community Plan members, state Medicaid requirements still apply.
Billing and Claims
Section 3704 of the Coronavirus Aid, Relief and Economic Security (CARES) Act expands telehealth capabilities for FQHCs and RHCs. For dates of service from Jan. 27, 2020 through July 24, 2020, UnitedHealthcare will reprocess all impacted claims, updating to the new CMS rate for telehealth services provided by FQHCs and RHCs. No action is required by care providers to initiate the reprocessing.
During the national public health emergency period, the Centers for Medicare & Medicaid Services (CMS) is allowing Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) to provide and bill for visiting nursing services by a registered nurse (RN) or licensed practical Nurse (LPN) to homebound individuals in designated home health agency shortage areas. No request for this determination is required.
This applies to all UnitedHealthcare Medicare Advantage benefit plan members, including DSNP members, who are:
Claims and Billing
FQHCs or RHCs should bill for visiting nursing services according to their normal billing requirements and will be reimbursed according to their designated reimbursement methodology. FQHCs and RHCs can bill for professional-related claims and will be reimbursed separately based on a professional fee schedule.
We encourage you to take this time to train additional staff to use our online self-service tools on Link. They’re more important than ever to quickly verify eligibility, submit claims, check claim status, submit prior authorizations or submit claim reconsideration requests. These tools will help create efficiency, support your at-home employees and allow you to spend more time with your patients rather than on the phone.
To use our self-service tools on Link:
Our standard processes, policies and procedures across all network plans and lines of business will continue to apply unless we have communicated a change. Any COVID-19-related changes will be outlined on this site as new information becomes available.
The benefits and processes described on this website apply pursuant to federal requirements and UnitedHealthcare national policy during the COVID-19 national public health emergency period. Additional benefits or limitations may apply in some states and under some plans during this time.
We will adjudicate benefits in accordance with the member’s health plan.
As health care professionals and facilities adjust to the COVID-19 national public health emergency period, use the following guidance to keep your demographic information updated in our systems.
To notify UnitedHealthcare of a new temporary service address:
Facilities – When you submit your change request, specify that the request is related to COVID-19. Please either follow the normal process for submitting demographic changes or send the change to your local network management team. Continue to submit claims using your primary service address, billing address, tax ID number (TIN) and national provider identifier (NPI). Use the place of service that would have been furnished had the service been provided at your primary location.
If there is a different TIN and/or billing address for your temporary service address, follow the normal process for submitting demographic changes.
To notify UnitedHealthcare of a new health care professional joining your medical group during the COVID-19 national public health emergency period:
Please either follow your normal process to submit a request to add a new health care professional to your TIN or contact your network management team. Indicate that the change is related to COVID-19.
To notify UnitedHealthcare of a temporary practice or facility closure:
We track these temporary closures to help resolve access to care issues for our members. When you return to normal operations, submit another demographic update request with the reopen date.
For Individual and Group Market health plans: UnitedHealthcare is following the IRS/DOL regulation related to the national emergency declared by the President.* This regulation pauses the timely filing requirements time clock for claims that would have exceeded the filing limitation during the national emergency period that began on March 1, 2020.
When an end date for the national emergency period has been declared, there will be an additional 60-day extension of timely filing requirements for claim submissions following the last day of the national emergency period.
For Medicare Advantage and Medicaid Plans: As of July 1, 2020, UnitedHealthcare is following standard timely filing requirements. Medicaid state-specific rules and other state regulations may apply. For Medicaid and other state-specific regulations, please refer to your state-specific website.
*The national emergency as declared by President Trump, distinct from the national public health emergency declared by the U.S. Department of Health and Human Services.
We’re committed to keeping you up to date on COVID-19 – we’re monitoring your inquiries and working hard to answer your questions. Let us know how we’re doing.
We’ll be making daily updates to this site. Be sure to check back often for the latest information.
The benefits and processes described on this website apply pursuant to federal requirements and UnitedHealthcare national policy during the national emergency. Additional benefits or limitations may apply in some states and under some plans during this time.
We will adjudicate benefits in accordance with the member’s health plan.
Medicaid Providers: UnitedHealthcare will reimburse out-of-network providers for COVID-19 testing-related visits and COVID-19 related treatment or services according to the rates outlined in the Medicaid Fee Schedule.