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[Editor's note: Additional information has been added to this article since its original publication on Nov. 29. UHC has clarified that its acceptance of treatment time in lieu of start and stop time is specific to commercial and individual exchange plans, and is encouraging providers to contact UHC with questions. As of this update on Dec. 12, 2023, UHC has not yet published written guidance on the use of treatment time in lieu of start and stop time.]

 

Providers who contract with insurer UnitedHealthcare experienced a rollercoaster ride over the summer, when the company first announced a series of expanded plan of care policies that contained some burdensome provisions for PTs, then walked back one of the most problematic requirements. Now, APTA has received clarification on another issue that may make things easier for providers working with UHC commercial and individual exchange plans.

The latest news: UHC informed APTA health policy and payment staff that its provision requiring PTs to document start and stop times for each follow-up treatment session could be met by providing total treatment time instead for commercial and individual exchange plans. The clarification applies to benefit plans that have a medical necessity requirement for habilitation, rehabilitation, and maintenance therapies. UHC has not issued a formal clarification as of this article's update on Dec. 12, 2023.

The full set of management guidelines, which includes the stop-and-start requirement, is available for review online. UHC encourages providers to reach out to UHC Provider Services, their provider advocate, or a network representative with questions.

[Be sure to stay on top of provider policies. Regularly review the UnitedHealthcare Administrative Guide and other resources available on the UnitedHealthcare provider portal.]


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