Last modified: November 11, 2020
In Arkansas and Ohio, we’re implementing a new Outpatient Hospital Observation and Facility Reimbursement Policy (Observation Policy) starting Jan. 1, 2021 for our commercial members.
Under the new Observation Policy, observation services reported by facilities must be:
Observation services should not be:
When the criteria for the direct admission of a patient for observation care HCPCS G0379 is met, it should be reported in addition to the hospital observation service to be considered for reimbursement.
Claims for observation that do not align with the Observation Policy will be denied. You’ll have the option to resubmit the denied claim according to the terms of your contract and/or the UnitedHealthcare Administrative Guide.
As with all commercial plan policies, other factors affecting reimbursement may supplement, modify, or in some cases, supersede this policy. These factors include, but are not limited to, federal and/or state regulatory requirements, physician or other care provider contracts, medical policies, other reimbursement policies and/or the member’s benefit coverage documents.
We’re here to help
More information on our policies is available at UHCprovider.com Reimbursement Policies.
If you have questions, please contact your network representative or call Provider Services at 877-842-3210.