Home Health Updates for Prior Auth and Bill Type 320
When OMN entered the market January 1, 2015, the standard Prior Authorization process for Home Health Care services was not enforced due to a large volume of cases transitioning from UnitedHealthcare (UHC) to OMN and to facilitate an uninterrupted transition for our members and providers into our Medical Management program.
- 1.
Beginning September 1, 2015, OMN will enforce our Home Health Care Prior Authorization requirements. Our Prior Authorization requirements are posted online: Unitedhealthcareonline.com > Tools and Resources> Policies Protocols and Guides> Advance and Admission Notification Requirements> United Health Care Medicare Advantage> Notification Procedure Codes
- 2.
Our Home Health Care Coverage Summary is also posted online: Unitedhealthcareonline.com> Tools and Resources> Policies Protocols and Guides> United Health Care Medicare Advantage Coverage Summary.
- 3.
OMN requests the following information in order to consider prior-authorization of home health services for days 61 and beyond: the type of home health visits, number of visits requested, specification of skilled service being performed, and confirmation that the visits were ordered by a physician.
- 4.
This information should be communicated to the OMN Prior Authorization team via the CMS-485 when submitted with the OMN Prior Authorization form. We will accept CMS-485 for the recertification prior authorization request that is not signed by a physician, if a signed copy is unavailable. The Physician’s verbal orders are required to be documented on the CMS-485 as received and signed by a Registered Nurse. This form should be submitted within 10 business days of recertification. The Prior Authorization form can be sent interim as a notificationwithout the CMS-485; however, the authorization cannot be finalized and claims paid until receipt of the CMS-485.
- 5.
Please submit prior authorization requests to OMN. The preferred method of submission is online through our Provider Portal. Online Prior Authorization: OptumMedicalNetwork.com>Utah>Providers. Go to the Providers Login box to register for and access the Provider Portal.
If you have secure email, Prior Authorization Email: LCD_UM@optum.com
Prior Authorization Fax Number: (888) 992-2809
Prior Authorization Phone Number: (877) 370-2845.
- 6.
If a denial for Home Health Aide or other non-covered services is appropriate or required to bill a secondary payer, please bill those services under the Bill Type 320. We follow CMS guidelines for services such as Home Health Aides and require those services that do not meet CMS coverage guidelines to be billed with the Bill Type 320. If upon request of prior authorization for additional services we identify payment of non-covered services, we will recover payment for those services.
- 7.
Our Prior Authorization or Medical Management department may request additional records or documentation to confirm that standard criteria is met for the services being authorized, previously authorized or billed. Please submit record requests to OMN’s Prior Authorization department via fax at 1-888-992-2809 or if you have secure email, you may email information
to LCD_UM@optum.com.
- 8. Prior Authorization requirements are subject to change and may be contract dependent.
If you should have any questions or concerns with your claims or prior authorization services, we are ready to support and assist you. For claims, please call 877-886-6412. For prior authorization, please call 877-370-2845.
Thank you for your support as we transition and implement our Care Delivery programs. We value our relationship and look forward to working together to best meet the needs of your patients.
