For policies listed below that do not apply to UnitedHealthcare Community Plan Medicare products, as indicated in the Application section of each policy, please refer to the UnitedHealthcare Medicare Advantage Reimbursement Policies for further information.
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Community Plan Reimbursement Policies Terms and Conditions
Please read the terms and conditions below carefully.
Important Note about Reimbursement Polices
All provider notification regarding UnitedHealthcare Community Plan reimbursement and medical policies will be posted on this website.
The UnitedHealthcare Community Plan Reimbursement policies are generally based on national reimbursement determinations, along with state government program reimbursement policies and requirements. Please note that where a specific conflict between a provision of a contract between UnitedHealthcare Community Plan and an applicable state program a provider contracts or state/federal regulations, such contract/regulation will supersede these reimbursement policies.
Important Policy Note
You are responsible for submission of accurate claims requests. This reimbursement policy is intended to ensure that you are reimbursed based on the code that correctly describes the procedure performed. This and other UnitedHealthcare Community Plan reimbursement policies may use CPT, CMS or other coding methodologies from time to time. References to CPT or other sources are for definitional purposes only and do not imply any right to reimbursement. This reimbursement policy applies to all professionals who deliver health care services. Coding methodology, industry standard reimbursement logic, regulatory requirements, benefits design and other factors are considered in developing reimbursement policy.
This information is intended to serve only as a general reference resource regarding UnitedHealthcare Community Plan’s reimbursement policy for the services described and is not intended to address every aspect of a reimbursement situation. Accordingly, UnitedHealthcare Community Plan may use reasonable discretion interpreting and applying this policy to services being delivered in a particular case. Further, the policy does not cover all issues related to reimbursement for services rendered to UnitedHealthcare Community Plan enrollees as legislative mandates, the physician or other provider contract documents, the enrollee’s benefit coverage documents, and the Physician Manual all may supplement or, in some cases, supercede this policy. Finally, this policy may not be implemented in exactly the same way on the different electronic claim processing systems used by UnitedHealthcare Community Plan due to programming or other constraints; however, UnitedHealthcare Community Plan strives to minimize these variations.
UnitedHealthcare Community Plan may modify this reimbursement policy from time to time by publishing a new version of the policy on this website; however, the information presented in this policy is believed to be accurate and current as of the date of publication.
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Observation and Discharge Policy, Professional - UnitedHealthcare Community Plan
Last Modified 02.12.2020,
Preventive Medicine and Screening Policy - Reimbursement Policy - UnitedHealthcare Community Plan
Last Modified 02.04.2020
Provider Preventable Conditions: Health Care Acquired Conditions and Present on Admission Policy, Facility - Reimbursement Policy - UnitedHealthcare Community Plan
Last Modified 01.14.2020