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Use of Unlisted CPT or HCPCS Codes

Mon, 2016-03-28 09:59 To facilitate the prompt adjudication of claims, providers are reminded to submit documentation with any claim that contains an unlisted CPT or HCPCS code. Because an unlisted code can represent a wide variety of services, documentation should clearly indicate the procedure, service...

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Non-Participating Lab Practices: Waiving or Capping Member Cost Share Prohibited

Mon, 2016-03-28 09:57 UnitedHealthcare’s laboratory network includes more than 1,500 clinical reference laboratories to support patients. Network care providers are expected to refer their members to network laboratories for clinical lab and anatomic pathology, unless otherwise authorized by UnitedHealthcare consistent with their participation agreement. Some...

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Lead toxicity screening

Mon, 2016-03-28 09:53 Lead toxicity screening is required for all Apple Health-enrolled children age 12 months and 24 months, regardless of lead exposure risk. This is not a new requirement. This is a clarification of an existing requirement from CMS. Washington State has requested a...

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New 2016 CPT and HCPCS codes

Mon, 2016-03-28 09:44 Effective March 21, 2016, rates and prior authorization (PA) requirements for the new 2016 CPT and HCPCS codes will be updated in the Nevada Medicaid Management Information System (MMIS). Providers are reminded to use the appropriate 2016 codes, when applicable, on claims...

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