WASHINGTON, D.C. – UnitedHealth Group (UHG) has released an update on expected timelines for Change Healthcare to resume operations and additional guidance on UHC Medicare Advantage authorization for DME and their temporary funding program. In addition, DME MAC Jurisdiction B & C contractor CGS has provided additional information on resources to help take advantage of recently issued CMS flexibilities.
UHG DME Prior Authorization
UHG’s latest release states “For Medicare Advantage plans, including Dual Special Needs Plans, we are temporarily suspending prior authorizations for most outpatient services except for Durable Medical Equipment [emphasis ours], cosmetic procedures and Part B step therapies.”
UHG Temporary Funding Relief Program
The release also notes that Optum is expanding its provider funding program “to include providers who have exhausted all available connection options, and who work with a payer who has opted not to advance funds to providers during the period when Change Healthcare systems remain down.”
The update also adds more detail on repayment requirements: “For those who receive funding support, there are no fees, interest or other associated costs with the assistance. For repayment, providers will receive an invoice once standard payment operations resume and will have 30 days to return the funds. These terms now apply to both the original and expanded funding programs.”
UHG Timeline Restoring Change Healthcare Systems
UHG also asserts that, assuming the current rate of progress, they expect key system functionality to be restored and available on the following timelines:
- Pharmacy services:Electronic prescribing is now fully functional with claim submission and payment transmission also available as of today. We have taken action to make sure patients can access their medicines in the meantime, including Optum Rx pharmacies sending members their medications based on the date needed.
- Payments platform:Electronic payment functionality will be available for connection beginning March 15.
- Medical claims: We expect to begin testing and reestablish connectivity to our claims network and software on March 18, restoring service through that week.
CGS Resources to Help Take Advantage of HHS Flexibilities
As we reported on Mar. 5, HHS announced actions and flexibilities to alleviate potential operational disruptions and reimbursement delays. Today, DME MAC contractor CGS shared specific CGS resources that align with the flexibilities outlined in the HHS statement, including:
- CEDI list of approved software vendors, billing services and clearinghousesalternatives to send claims to and/or receive ERAs from CEDI.
- CEDI Claims Portalfor manual entry of claims and to retrieve the ERA.
- Details on how to request an ASCA waiver to submit paper claims.
- Link to request Accelerated and Advance Paymentfor suppliers experiencing significant cash flow problems stemming from this disruption.
Resources and Links
