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Moderate Sedation Reimbursement Policy

Fri, 2017-01-27 10:53 The current UnitedHealthcare Moderate Sedation reimbursement policy for Commercial plans will be retired effective Jan. 1, 2017. Per the 2017 CPT book, moderate sedation codes 99143-99145 and 99148-99150 have been deleted and replaced by new CPT codes 99151-99157. Additionally, Appendix G in...

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Expansion of Radiology and Cardiology Notification/Prior Authorization Protocols to All Savers Plans (Offered Off-exchange) – Effective April 1, 2017

Fri, 2017-01-27 10:52 Effective April 1, 2017, care providers must provide notification prior to scheduling a planned service that is subject to UnitedHealthcare’s Outpatient Radiology Notification/Prior Authorization Protocol and Cardiology Notification/Prior Authorization Protocols for a UnitedHealthcare All Savers (offered off-exchange) member. These members can be...

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Claim adjustment requests

Fri, 2017-01-27 10:51 Blue Cross Blue Shield of North Dakota (BCBSND) is providing a clarification to the current claim adjustment request policy. Effective January 1, 2017, all claim adjustment requests must be submitted 180 days from the original payment listing date. Claim adjustment requests submitted...

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Diagnostic Mammography Coverage Mandate

Fri, 2017-01-27 10:50 There is a New York state coverage mandate going into effect January 1, 2017, expanding the existing health insurance benefit for screening mammography to include diagnostic imaging for the detection of breast cancer. The expanded services include diagnostic mammograms, breast ultrasounds, digital...

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DHCS Fiscal Intermediary Name Change

Fri, 2017-01-27 10:45 Xerox State Healthcare, LLC is the current Medi-Cal Fiscal Intermediary for the Department of Health Care Services’ (DHCS) fee-for-service system. Earlier this year, it was announced that the parent company of Xerox State Healthcare, LLC will separate from Xerox Corporation and become...

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