Protocol for Non-Covered Services
UnitedHealthcare must issue a determination before you render or refer for the non-covered service or item. If you know or have reason to believe that a service or item you are providing or referring may not be covered, you must request a pre-service organization determination from UnitedHealthcare prior to providing or referring for the service or item in order to seek and collect payment from a Medicare Advantage member for the service or item.
A pre-service organization determination is not required in order to seek and collect payment from the member where the Medicare Advantage Member’s Evidence of Coverage (EOC) or other related materials are clear that a service or item is never covered.
You must obtain the member’s written consent before non-covered services are rendered. For more information go to UnitedHealthcareOnline.com > Tools & Resources > Policies, Protocols and Guides > Protocols.
UnitedHealthcare must issue a determination before you render or refer for the non-covered service or item. If you know or have reason to believe that a service or item you are providing or referring may not be covered, you must request a pre-service organization determination from UnitedHealthcare prior to providing or referring for the service or item in order to seek and collect payment from a Medicare Advantage member for the service or item.
A pre-service organization determination is not required in order to seek and collect payment from the member where the Medicare Advantage Member’s Evidence of Coverage (EOC) or other related materials are clear that a service or item is never covered.
You must obtain the member’s written consent before non-covered services are rendered. For more information go to UnitedHealthcareOnline.com > Tools & Resources > Policies, Protocols and Guides > Protocols.
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