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United Healthcare Community Plan – Payer 87726

(Last Updated On: September 5, 2017)

United HealthCare Community Plan- effective Nov 24, 2016. An EPSDT Visit coding is required for Early and Periodic Screen, Diagnostic and Treatment (EPSDT) Visits. This change is being done in order to become compliant with the State requirements. Claims will be denied if this information is not included when submitting claims for certain CPT and Diagnosis codes. (Click here for further details.)

CMS1500 form: The codes will populate field 10D. Also, box 24 will have a Y in 24H.

NEIC_P5 – Will populate the Referral Code in the NTE*ADD record and indicate EPSDT is used by entering a ‘Y’ in the SV1 segment.

NOTE: Provider must be on PM VERSION 6.1.8 or higher in order to have the YN – No Referral code in the drop-down. All other codes are available in previous versions.

When entering a charge for theses procedure coded:

  • Click the Custom button in the Charge screen.
  • Under Billing Instruction Codes, click the down arrow.
  • Locate the codes beginning with EPSDT
  • Click the code the relates to the Referral Code that is required.
  • These EPSDT codes will work for any insurance regardless of the payer id on the insurance screen.

    If you have any questions please contact Practice Manager Support for assistance.

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