Providers will receive notification from CMS of their placement on the Preclusion List by letter and will have the opportunity to appeal with CMS before the preclusion is effective.
There will be no opportunity to appeal with UnitedHealthcare. Once the preclusion date is effective, claims will no longer be paid, pharmacy claims will be rejected and the care provider will be terminated from the UnitedHealthcare network if they are contracted until such time they are removed from the preclusion status.
As contracted care providers of UnitedHealthcare, you must ensure that payments for health care services or items are not made to individuals or entities on the Preclusion List, including employed or contracted individuals or entities.
Enterprise Medical Records Program
We all know how exhausting medical record requests can be, from demands on staff time to delays in claims processing. Now UnitedHealthcare is making it easier for you and your practice.
How It Works
You’ll grant UnitedHealthcare direct access to your EMR system. Whenever UHC needs a specific medical record to process a claim or complete a review, they’ll remotely access your EMR system in a way that is compliant with HIPAA and all privacy regulations. The secure transfer will download the information into a secure repository where the medical requester will review the records.
How to Get Started
To join the EMR All Access program, you’ll need to provide UnitedHealthcare medical record reviewers with access licenses and allow medical record download and storage in compliance with regulatory requirements. While the process meets HIPAA and other compliance regulations, all medical records must be kept up to date to help ensure UHC reviewers are accessing current information.
Ready to Get Started?
Email to EMR.email@example.com
Learn more here.
Medical Record Review
United Healthcare is required by the Department of Health & Human Services (HHS), under the Affordable Care Act (ACA), to submit complete diagnostic information about members enrolled in certain Commercial ACA-covered health plans. You may get a request for medical records to comply with this requirement from Dec. 3, 2018 through March 15, 2019.
What This Means to You
If you’re selected for a medical record review, UnitedHealthcare will ask you to provide information for 2018 dates of service for a certain number of your patients.
What You Will Need to Do
All requested medical records and documentation will need to be completed March 15, 2019 to meet the HHS deadline for these record requests.
Medical Record Documentation Required:
When you get the medical record request, you’ll be asked to provide the following documentation:
- Consult notes
- Discharge summary
- Emergency department records
- History and physical notes
- Operative and pathology notes
- Patient demographics sheet
- Physical, speech and/or occupational therapist reports
- Physician orders
- Problem list
- Procedure notes/reports
- Progress notes and/or SOAP notes for face-to-face office visit
- Signature Log*
* HHS requires to validate care providers’ signatures and qualifications for each medical record to review.
It’s important that you provide a signature log, with credentials to identify signatures of physicians, physician assistants, and nurse practitioners who are mentioned in or have annotated medical records.
If you have any questions about the scheduling of the medical record review:
- Call CIOX Health at 877-445-9293, between 7 a.m. to 8 p.m., CST, Monday through Friday, or
- Email firstname.lastname@example.org