UHC's Medicare plan will soon define new patients differently

UnitedHealthcare (UHC) recently announced it will change its Medicare Advantage (MA) new patient visit payment policy to align with Centers for Medicare & Medicaid Services (CMS) guidelines.

Effective Aug. 1, UHC will define a new patient as one who has not received any professional services, i.e., evaluation and management (E/M) or other face-to-face service (e.g., a surgical procedure) from the same physician or a physician in the same group practice with the same specialty, within the previous three years. UHC’s current policy only applies denials to new patient visits when a patient received an E/M service by the same individual or physician group within the prior three years — other face-to-face services are not a factor.  

That will change with the updated policy, which will impact claims processed on or after Aug. 23.

Contact your local UHC provider relations representative if you have questions about the new policy.

— Brennan Cantrell, AAFP Commercial Health Insurance Strategist

Posted on July 20, 2023