12/16/2020

Managed Care Committee Reimbursement TIDBITS

Featuring this month: UnitedHealthcare Community Plan

TidBits thanks to

SHELBY JENSEN

MSHO Managed Care Committee

Did you know.... Eff: 11/1/2020 UHC Community Plan started implementing a new “Inappropriate Primary Diagnosis Policy” for facility claims. This policy will deny claims where an inappropriate diagnosis is in box 67 on a UB-04 claim or its electronic equivalent.  Providers can resubmit corrected claims with the correct dx coding.

Did you know.... Eff: 10/1/2020 the Michigan Department of Health and Human Services (MDHHS) will require Medicaid Health Plans (MHPs) to follow the Michigan Fee-For-Service Preferred Drug List (PDL). Members should have been sent a letter prior to this date if they were to be impacted.

Did you know.... UHC Community Plan updates their prior authorization plan requirements on a monthly basis so be sure to always check before a patient receives treatment.

NOTE: A different Michigan Payer will be featured monthly.

 Visit the MSHO Website for a listing of the Michigan Health Plans and the MSHO Managed Care Committee.

CLICK HERE