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2023 UHC Updates

We remain focused on keeping you up to date on the latest policy updates and as of now, here is what we know about the two latest UHC updates. 

Digital Submission Update

Beginning on February 1st, UnitedHealthcare (UHC) will start requiring digital submissions of appeals and reconsiderations. UHC believes the shift from paper to digital will not only minimize mail delays and processing time but ensure timely filing deadlines are met for healthcare professionals. 

Moving forward, electronic submission options include: 

  1. Accessing the UnitedHealthcare Provider Portal to manage claims by specific claim number. Here you can submit a claim through the portal. 
  2. Submitting reconsiderations and appeals through the Application Programming Interface (API). UHC recommends allowing two business days for an API Consultant to contact you. 

As the shift to digitalization continues, we encourage UnitedHealthcare commercial members to use digital ID cards and explore digital options to make sure your team is prepared. If you have questions, UHC Provider Services can be reached at 877-842-3278 or providertechsupport@uhc.com

Screening Colonoscopy – Site of Service Update:

Benefit coverage for health services is determined by the member-specific benefit plan and may also be affected by certain documentation requirements.

The American Society of Anesthesiologists (ASA) classification system for a patient’s physical status was developed to categorize a patient’s physiological status which can be helpful in predicting the operative risk.

Medical necessity reviews are conducted by carriers, to determine the medical necessity of procedures as well as the site of service facilities. Services that can safely be performed in an ambulatory surgery center (ASC) versus an outpatient hospital facility may be under higher scrutiny by payers. 

Medical necessity for the patient may be determined in accordance with the documentation of the physical status. ASA classification level is a clinical decision based on multiple factors. The ASA has published current definitions and approved ASA examples. 

The purpose of the ASA classification system is to assess and communicate a patient’s pre-anesthesia medical co-morbidities. If the location of the screening colonoscopy is an outpatient hospital, it is recommended to include during the preoperative anesthesia assessment the clear documentation supporting the co-morbidities of the patient when evaluating the patient.

For more information, visit UnitedHealthcare

Please let us know if you have any questions on these latest two UHC Updates! 

The ACE Team
aceadmin@aceauditors.com
913-648-8572

© 2021, Auditing for Compliance & Education, Inc.