10/02/2018
United Healthcare Update
HCCP DUAL ELIG PLAN
On Jan. 1, 2019, UnitedHealthcare will begin serving eligible members in a Dual Special Needs Plan (DSNP) – UnitedHealthcare Dual Complete,® a Medicare Advantage plan – in almost 250 new counties across the United States. This expansion includes two states new to the Dual Complete offering — Maryland and Kentucky — new to the Dual Complete offering and 16 states that will be expanding coverage by entering new service areas. This is a Medicare Advantage plan for members who qualify for both Medicare and Medicaid. DSNPs are a specialized type of Medicare Advantage Prescription Drug Plan (MAPD) and must follow existing Centers for Medicare & Medicaid Services (CMS) rules.
Michigan – Allegan, Barry, Bay, Calhoun, Kalamazoo, Kent, Mecosta, Montcalm, Newaygo, Ottawa, Saginaw, Sanilac, St. Joseph and Van Buren
These MI counties will be the only counties that will have this option. Please be careful in verifying coverage.
United Healthcare Update
As of 11/1/2018, Optum will be managing PA’s for UHCCP. Evicore will no longer be handling them.
(From the UHC newsletter)
Prior authorization will continue to be required for:
- Chemotherapy and biologic therapy injectable drugs (J9000 - J9999), Leucovorin (J0640) and Levoleucovorin (J0641)
- Chemotherapy and biologic therapy injectable drugs that have a Q code
- Chemotherapy and biologic therapy injectable drugs that have not yet received an assigned code and will be billed under a miscellaneous Healthcare Common Procedure Coding System (HCPCS) code
- Colony Stimulating Factors: J2505 (neulasta), J1442 (neupogen), J2820 LeukineR (sargramostim), Q5101 (Filgrastim– biosimilar Zarxio), J1447 Granix (tbofilgrastim)
- Denosumab (Brand names Xgeva and Prolia): J0897
Prior authorization will be required when adding a new injectable chemotherapy drug or cancer therapy to an existing regimen.
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Thanks for the tidbit from the MSHO Managed Care Committee Member:
Erika Dains, Medical Biller
Newland Medical Associates
Update to UHC Reimbursement Policy
(from the September UHC Network Bulletin)
The chart below contains an overview of the policy change and effective dates for the following policy: Injection and Infusion Services