UnitedHealthCare Rolls Out Advance Notification Program

UnitedHealthCare recently sent out correspondence to physicians and hospitals concerning their advance notification program. AMCNO leadership has discussed this program with the medical director of UHC and we have learned that consistent with current UHC practice physicians, health care professionals and non-facility providers rendering services are still required to provide notification for all admissions. However, in order to promote administrative simplification, as of December 3, 2007 UHC is reducing the number of inpatient admissions that would require advance notification. Failure to notify for specific elective procedures will impact reimbursement.

Physicians are responsible for advance notification for in patient services involving orthopaedic surgeries (spinal surgeries, total knee replacements and total hip replacements); transplants; reconstructive/potentially cosmetic procedures, and bariatric surgeries. The new rules for these specific in patient services will require advance notification at least 5 business days prior to planned admissions (or as soon as the admission is scheduled if it is scheduled less than 5 business days in advance.) Advance notification from the physician has to occur before the patient is admitted to the hospital.

Reimbursement reductions will occur only if the advance notification is not received. Reimbursement reductions will only impact the party who fails to meet their specific obligation under the program (i.e. physicians, health care professionals, non-facility providers and hospitals will no longer be impacted by another party’s failure to provide required notification.) However if a physician does not meet the obligations for advance notification when billing for a service on the advance notification list noted above they will be subject to reductions off the contracted rate BEFORE member benefits.

Hospitals will be required to notify UHC within 24 hours of the patient’s admission to the hospital. UHC will have 24-hour availability for hospital contacts. Reductions for late admission notification will apply equally to hospitals of ALL contracted types. If the hospitals fails to provide admission notification or admission notification is received more than 72 hours after admission UHC will apply a 50% reduction off the contracted rate for the entire admission before enrollee benefits (this applies only to hospitals related to any inpatient admission.) If the hospital provides a late admission notification (i.e. received more than 24 hours but within 72 hours after admission) they will be subject to a 50% reduction based on the computed average of the daily contracted payment rate for the days preceding notification (applies only to hospitals related to any inpatient admissions.)