United Healthcare Provider Policy Changes: What You Need to Know for September 1st, 2024

Hey there! Today, we’re diving into some important United Healthcare provider policy changes from United Healthcare that could impact many providers starting September 1st, 2024. But before we get too deep, a quick disclaimer: this isn’t a comprehensive guide to all the changes coming your way. This post will bring awareness about the changes, especially if they could affect you or your practice. It is essential to conduct your research to understand the details and how they might impact you.

Key Takeaways

• United Healthcare will require prior authorizations for certain therapy services starting September 1, 2024.
• Initial evaluations won’t need prior authorization, but all subsequent treatments will.
• Implement internal workflows to manage new authorization requirements effectively.
• Stay informed by subscribing to provider bulletins and regularly reviewing policy updates.
• Optum Services will handle all prior authorization reviews via the One Healthcare portal.

What’s Happening on September 1st, 2024?

On August 1st, United Healthcare announced several new policies that will take effect in the coming months—starting with September 1st, followed by additional changes on October 1st and November 1st. These policy updates will impact various specialties. But today, we’re focusing on the changes affecting Physical Therapy, Occupational Therapy, Speech Therapy, and Chiropractic Care.

Medical Policy Updates: August 2024

If you provide any of these services, it’s crucial to stay informed. Even if your practice doesn’t offer these services, I highly recommend subscribing to the UHC provider bulletin to keep up-to-date with all their updates. They release these bulletins monthly, and missing out on them could mean missing changes that might affect your practice.

The Big Change: Prior Authorizations for Therapy Services

Starting September 1st, 2024, United Healthcare will require prior authorizations for ongoing Physical Therapy, Occupational Therapy, Speech Therapy, and Chiropractic Care services in many states—far beyond the few states previously affected. Here’s what this means for your practice:

• Initial Evaluations will not require prior authorization.
• Subsequent Treatments and Treatment Plans will need prior authorization after the initial visit.

The United Healthcare provider policy changes suggest a grace period of about 10 days to obtain the necessary prior authorization after initiating services. However, don’t let this grace period lull you into a false sense of security. Best practice is to obtain the authorization as soon as you know it’s required—even before the initial evaluation. This helps ensure your authorization submissions are accurate, including all necessary CPT codes, diagnosis codes, and the anticipated length of treatment.

Why Waiting Until After the Initial Evaluation Makes Sense

While it might sound counterintuitive to wait until after the initial evaluation to get prior authorization, there’s a method to this madness. The initial evaluation allows you to gather all the necessary information to submit a comprehensive and accurate authorization request. This includes:

• Detailed treatment plans
• Accurate CPT and diagnosis codes
• Expected duration of the treatment

So, once that initial evaluation is complete, moving quickly is crucial. Ideally, within 24 hours, the provider should finalize their chart note and hand it off to the designated person responsible for securing the prior authorization.

Developing Internal Workflows to Adapt to the Changes

If these changes affect you, it’s time to roll up your sleeves and get to work! Here’s what you should do:

1. Research the specific guidelines and requirements outlined in the new policy.
2. Implement new internal workflows to ensure a smooth transition. One option is to designate someone in your office to handle all prior authorization requests.
3. Make sure that you schedule ongoing treatments only after obtaining the necessary authorizations. Remember, scheduling treatments without an authorization is risky—your claims could get denied if the authorization isn’t on file.

Who’s Responsible for Reviewing Authorizations?

United Healthcare is putting Optum Services in charge of reviewing prior authorization requests and the accompanying documentation. Providers will need to apply for prior authorization through the One Healthcare portal. You’re probably already familiar with this portal if you bill United Healthcare regularly. You’ll submit all necessary medical records and information through this portal, and Optum Services will review and either approve or deny the request on behalf of United Healthcare.

Don’t Forget About Multidisciplinary Locations and Medicare Advantage Plans

United Healthcare provider policy changes have a few more wrinkles. For example, the policy includes stipulations for multidisciplinary locations and specialties. Medicare Advantage plans are also affected, although there are some exclusions. Again, the specifics are in the policy bulletin, so check out the link in the video description for more details.

The ABCDs of Medicare: A Simplified Guide

And speaking of staying informed—sign up for the UHC provider bulletin! Some additional changes are coming down the line for October and November, potentially affecting orthopedics and medications. You want to stay ahead of these changes to ensure your practice runs smoothly.

Stay Proactive and Prepared

With September 1st just approaching, it’s crucial to be proactive. Ensure someone in your practice regularly checks updates from all providers you bill, not just United Healthcare. Keeping your finger on the pulse of these changes ensures you’re always prepared and compliant.

Diving Deeper into United Healthcare’s Policy Changes

Let’s continue by taking a closer look at navigating the United Healthcare provider policy changes starting September 1st, 2024. Suppose your practice provides Physical Therapy, Occupational Therapy, Speech Therapy, or Chiropractic Care. In that case, you’ll want to pay extra attention to how these new requirements affect your workflows, documentation, and patient interactions.

How to Handle Prior Authorizations Efficiently

Handling prior authorizations can be a headache, but you can minimize disruptions and avoid denials with a solid plan. Here’s how to streamline the process:

Designate a Prior Authorization Specialist: Assign a specific team member to handle all prior authorization requests. This person should be familiar with the One Healthcare portal and the specific requirements for each therapy or care you provide. They will be responsible for gathering the necessary information, submitting requests, and following up to ensure approvals are obtained promptly.

Create a Checklist for Required Documentation: Each authorization request will need to be supported by appropriate documentation. This often includes:

• Initial Evaluation Reports: Detailing the patient’s condition and the proposed treatment plan.

• CPT Codes: Specific to the services you intend to provide.

• Diagnosis Codes: Indicating the patient’s condition.

• Treatment Duration: An estimate of how long treatment is expected to last.

By creating a standardized checklist, you can ensure nothing is missed when submitting requests. This reduces the chances of delays or denials due to incomplete information.

Use the 10-Day Grace Period Wisely: While there is a 10-day grace period to obtain prior authorization after initiating services, it’s best not to rely on this timeframe. Aim to submit all necessary paperwork within the first 48 hours post-evaluation. This allows ample time for any follow-up questions or additional documentation requests from Optum Services.

Implement a Follow-Up System: Set up a system for following up on pending authorizations. This could be as simple as your authorization specialist checking in daily or weekly to ensure all requests progress. The One Healthcare portal’s tracking features can help organize this process.

Scheduling Patient Treatments with New Requirements in Mind

Deciding when to schedule ongoing patient treatments under the new requirements is a balancing act. Here are some strategies to consider:

• Wait Until Authorization is Secured: The safest approach is to wait until the prior authorization is confirmed before scheduling ongoing treatments. This way, you avoid the risk of claim denials, which can lead to revenue loss and patient dissatisfaction.
• Communicate Clearly with Patients: If you choose to schedule treatments before authorization is received, communicate with your patients about the potential risks. Explain that their insurance may not cover treatments if prior authorization isn’t obtained in time, and be upfront about any possible out-of-pocket costs.
• Optimize the Initial Evaluation: During the initial evaluation, gather as much information as possible to streamline the authorization process. Ensure your notes are thorough, accurate, and ready for quick hand-off to your authorization specialist.

Understanding the Role of Optum Services

Optum Services, a part of United Healthcare, will review all prior authorization requests and accompanying documentation. Here’s what you need to know:

• Submitting Through the One Healthcare Portal: All requests and supporting documents should be submitted through the One Healthcare portal. If you’re unfamiliar with this platform, now is the time to get comfortable with its features.
• Documentation Review: Optum Services will review the submitted documents to determine if the treatment plan is medically necessary and if it aligns with United Healthcare’s guidelines.
• Approval or Denial Notifications: Once a decision is made, you’ll be notified through the One Healthcare portal. It’s crucial to check these notifications regularly to avoid delays in patient care.

Special Considerations for Multidisciplinary Locations

If your practice operates as a multidisciplinary location or if you’re part of a larger healthcare system, here are some additional steps to consider:

1. Coordinate Between Departments: Ensure all departments affected by the policy changes (Physical Therapy, Occupational Therapy, Speech Therapy, and Chiropractic Care) know the new requirements and workflows. This might involve regular meetings or updates from a central point of contact.
2. Centralize Authorization Efforts: Consider centralizing your prior authorization efforts to streamline the process across multiple departments. This could help reduce redundancy and ensure consistency in documentation and communication.
3. Stay Informed About Medicare Advantage Plans: Some changes will also affect Medicare Advantage plans. Review which plans are excluded and adjust your workflows accordingly. This information should be available in the UHC provider bulletin.

Preparing for Future Changes in October and November

Looking ahead, United Healthcare has hinted at additional policy changes coming in October and November. These could affect other specialties, such as orthopedics, or involve updates to medication authorizations. To stay ahead of these changes:

• Subscribe to Provider Bulletins: Ensure your practice is subscribed to the UHC provider bulletin and any other relevant communications from insurers.
• Conduct Regular Policy Reviews: Assign a team member to review policy updates monthly. This person should identify any changes impacting your practice and report to the team.
• Adjust Your Workflows as Needed: Be prepared to adjust your workflows quickly as new requirements are announced. Flexibility is key to staying compliant and minimizing disruptions.

FAQ

What changes is United Healthcare implementing on September 1st, 2024?

Starting September 1st, 2024, United Healthcare will require prior authorizations for ongoing Physical Therapy, Occupational Therapy, Speech Therapy, and Chiropractic Care services in many states. Initial evaluations will not require authorization, but subsequent treatments will. This change impacts many providers and requires new workflows to ensure compliance.

Why is it important to obtain prior authorization before ongoing therapy services?

Obtaining prior authorization is crucial to avoid claim denials and ensure insurance covers services. After the initial evaluation, subsequent treatments must have authorization to be reimbursed. Failing to obtain authorization could lead to financial losses and disrupt patient care.

How should providers handle prior authorization requests under the new policy?

Providers should assign a dedicated team member as a prior authorization specialist. This person should handle all requests, complete documentation, and submit through the One Healthcare portal. Prompt submission and regular follow-ups are essential to avoid delays and ensure approvals are obtained in time.

What should be included in a prior authorization request for therapy services?

A prior authorization request should include the initial evaluation report, detailed treatment plan, specific CPT and diagnosis codes, and an estimate of the treatment duration. Ensuring all these elements are included helps prevent delays or denials due to incomplete information.

How can multidisciplinary practices adapt to United Healthcare’s new policy changes?

Multidisciplinary practices should be coordinated between departments to ensure everyone is aware of the new requirements. Centralizing authorization efforts and reviewing policy updates can help streamline the process, reduce redundancy, and maintain compliance across all affected specialties.

What role does Optum Services play in United Healthcare’s new policy changes?

Optum Services reviews all prior authorization requests and accompanying documentation on behalf of United Healthcare. Providers must submit requests through the One Healthcare portal. Optum Services will determine if the treatment plan is medically necessary and approve or deny the request accordingly.

How can providers stay ahead of future United Healthcare policy changes?

Providers should subscribe to the UHC provider bulletin and regularly review policy updates. Assigning a team member to monitor these updates and report changes to the team can help ensure the practice is always prepared and compliant with new requirements.

What are the potential risks of scheduling treatments before securing prior authorization?

Scheduling treatments before securing prior authorization risks claim denials, which can result in revenue loss and patient dissatisfaction. Providers should communicate these risks to patients and consider waiting until authorization is confirmed to avoid these issues.

Why is it essential to keep updated with provider bulletins from United Healthcare?

Provider bulletins from United Healthcare contain crucial updates on policy changes that could affect your practice. Staying updated ensures you know new requirements and helps maintain compliance, avoid claim denials, and provide seamless patient care.

Final Thoughts

Navigating the upcoming United Healthcare provider policy changes can feel overwhelming, but staying informed and proactive will help your practice adapt smoothly. From understanding the importance of obtaining prior authorizations for therapy services to developing internal workflows and keeping up with ongoing updates, these steps are crucial to maintaining compliance and minimizing disruptions in patient care. By implementing the strategies discussed in this guide, your practice can avoid pitfalls like claim denials and financial losses.

By reading this post, you’ve equipped yourself with the knowledge and tools to handle these changes effectively. Stay ahead of the curve, protect your revenue, and ensure a seamless patient experience. Remember, being prepared is the best way to thrive amid changes—your practice’s success depends on it!

As always, don’t hesitate to contact us with any questions or comments about these updates. If you found this breakdown helpful, don’t forget to share it with your colleagues who might benefit from staying in the know!