UnitedHealthcare Medicare Advantage Plan Changes

October 27, 2019
Rick Gawenda

Since January 1, 2019, facilities that provide post-acute care inpatient services have been required to request prior authorization and receive a pre-service determination before UnitedHealthcare (UHC) Medicare Advantage Plan members can be admitted to a post-acute care facility or a post-acute care bed in one of the following types of facilities:

  • Acute Inpatient Rehabilitation
  • Skilled Nursing Facilities
  • Long-term Acute Care Hospitals
  • Critical Access Hospitals that provide post-acute services

Beginning on October 1, 2019, UHC will

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  1. Hi–we have had some denials of UHC Medicare Advantage Plan denying Self Care Home Management (97535) when being billed with IE (97162) with reason being “decision is based on LCD”. I have reviewed the cms LCD and do not see anything re: this claim. Medicare itself is not denying it billed the same way. Can you advise please?