UnitedHealthcare July 2023 Medical Policy Update
UnitedHealthcare (UHC) has revised their Habilitation and Rehabilitation Therapy (Occupational, Physical and Speech) medical policy for their Commercial and Oxford Products. The revised effective date is July 1, 2023.
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Did this revision now just add the requirement for POCs, and noting the start and stop times, or was this also required prior to July 1st?
Do UHC patients now need a POC signed by a Dr, or when it says or appropriate specialist, would that include a licensed physical therapist?
You would need to contact UHC and ask them that question.
Hello Rick,
We have recently received requests for UHC patients for all dates of service physical therapy was provided. UHC recoops their money for these services stating not medically necessary. We have a doctors order, signed plan of care and provided a service that we believed was medically necessary. Do you have any insight of how to prevent this from happening? We cannot accept this insurance if we are providing free services.
Based on what you are saying, it sounds as if you might need to improve in your documentation to demonstrate the skills of a therapist were required to provide the therapy services.
Is this requirement for all UHC policies or just the ones that require authorization?
We dropped UHC over a year ago and are out of network. Do we still need to follow these POC and time rules?
If the patient has OON benefits and a claim is being submitted to UHC, I would say yes.
Im assuming this is only for patients with referring physicians and does not change the direct access process?
That would be an incorrect assumption. Per the policy as it stands now, you have to have a signed and dated plan of care. Think of it as the same as traditional Medicare.