UPDATES
January 25, 2008: View updated information about admission notifications.
Overview
Effective December 3, 2007 (for most states*), our notification requirements and processes are changing. Advance and Admission Notification requirements will apply to services rendered to members whose products are addressed in the Administrative Guide which include the following: UnitedHealthcare Choice, Choice Plus, Select, Select Plus, SecureHorizons plans with the “UHC” indicator on the back of the member's ID card and Evercare (excluding Evercare Medicaid plans and Erickson Advantage).* Advance Notification - For Physicians, Health Care Professionals and Non-Facility Providers
You are required to furnish notification to UnitedHealthcare at least five business days prior to the planned service date for a select list of planned acute care services (unless otherwise specified) on the Advance Notification List (in the revised Administration Guide language document below). If services are planned less than five business days prior to the service date, notification is required as soon as the service is scheduled. Admission Notification - Acute Care Hospitals, Skilled Nursing Facilities and Acute Rehabilitation Facilities
The existing notification requirement will be modified to require notification of each inpatient admission within 24 hours after the admission. Note: It is important that you continue to consult and comply with all other protocols provided in the Administrative Guide.
*Excluded: The states of Maryland, Nevada and Washington. Also excluded: Benefit plans for beneficiaries of governmental programs other than Medicare (such as Medicaid and CHIP) and benefit plans offered or administered by other UnitedHealthcare affiliates (including Arnett Health Plans, UnitedHealthcare of the River Valley, Neighborhood Health Partnership, PacifiCare, Oxford Health Plans, MD Individual Practice Association Inc. (M.D. IPA), Optimum Choice Inc, and MAMSI Life & Health (MLH)) which maintain separate or additional protocols and/or administrative guides. The existing requirements regarding notification, authorization and/or pre-certification for these entities remain in place. |
