Update from UnitedHealth Care Regarding Advance Notification Changes

The UHC medical director has notified the AMCNO that there has been some confusion on the part of physicians regarding the updates in the Advance Notification and Admission Notification changes that took effect with UnitedHealthcare on 12/03/07. It is important to remember that the only inpatient services requiring advance notification by the physician are spinal surgery; total hip and total knee replacement surgery; bariatric procedures; transplants; and cosmetic/reconstructive procedures. Basically, the list of services has been drastically reduced that physician need to notify UnitedHealthcare in advance, and represents a lessening of the administrative burden for the physician office.

The revised Admission Notification protocol in effect December 3, 2007 indicates that responsibility for notification of all hospital admissions is now the responsibility of the hospital. There is no requirement for notification or concurrent review for observation stays. The hospital is required to notify UHC after the patient has been admitted to inpatient status for services, and no later than 24 hours after admission starting December 3, 2007. 

UHC has informed the AMCNO that they have received a tremendous amount of feedback from hospitals on the requirement for admission notification with in 24 clock hours instead of 1 business day relative to weekends and holidays. Many hospitals expressed an operational inability to proceed with weekend and holiday notification requirements at this time. Based upon this feedback the reimbursement impact to hospitals for failure to notify within 24 hours on weekends and holidays has been postponed until after March 31, 2008. The one business day standard will remain in effect from Dec 3, 2007 - March 31, 2008 for weekend and holiday admissions. It is the goal that operational readiness for hospitals will be in place by April 1, 2008. Reimbursement impact procedures for hospitals will begin at that time.

UHC has also notified the AMCNO that they wanted to assure physicians that they are not penalizing UHC network physicians if they refer to non-network physicians effective December 3, 2007. 

If you have further questions about any aspect of our Advance Notification protocol, please refer to the FAQ (Frequently Asked Questions) on the UHC Web site at www.unitedhealthcareonline.com  - under the link clinician resources/care management/advance and admission notification.