It was previously communicated Oct. 1, 2020, on the Community Plan Portal, that the UnitedHealthcare Community Plan is implementing a new Inappropriate Primary Diagnosis Policy, Facility, for facility claims. Implementation of this new facility policy has been delayed until on or after date of process June 1, 2021:
The International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) Official Guidelines for Coding and Reporting, developed through a collaboration of the Centers for Medicare & Medicaid Services (CMS), the National Center for Health Statistics (NCHS) and the Department of Health and Human Services (HHS), provides clear direction on the coding and sequencing of diagnosis codes. Using the ICD-10-CM Official Guidelines for Coding and Reporting, this policy identifies diagnosis codes that should never be billed as primary on an outpatient hospital (UB-04) claim form or its electronic equivalent.
You can find these updates at Reimbursement Policies for Community Plan.
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If you have questions about policy updates, please contact your Network Account Manager or Provider Advocate. Thank you.