UnitedHealthcare Dual Complete is a type of Medicare Advantage plan that provides healthcare coverage for people who are eligible for both Medicare and Medicaid. If you are a healthcare provider who works with patients who have UnitedHealthcare Dual Complete, it is important to know how to bill for services. In this article, we will provide a guide on how to bill UnitedHealthcare Dual Complete, including information on eligibility, authorization, and payment.Early Finder

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Eligibility for UnitedHealthcare Dual Complete

UnitedHealthcare Dual Complete is available to people who are eligible for both Medicare and Medicaid. To be eligible for Medicare, a person must be 65 years or older or have a qualifying disability. To be eligible for Medicaid, a person must have a low income and meet other criteria established by their state. If a person is eligible for both Medicare and Medicaid, they may enroll in UnitedHealthcare Dual Complete.

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Authorization for Services

Before providing healthcare services to a patient with UnitedHealthcare Dual Complete, it is important to obtain authorization. UnitedHealthcare Dual Complete uses a prior authorization process to ensure that the services being provided are medically necessary and appropriate for the patient’s condition. To obtain authorization, you will need to contact UnitedHealthcare Dual Complete’s authorization department and provide information about the patient’s medical condition, the proposed treatment or service, and any other relevant information. Once you have obtained authorization, you may proceed with providing the services.

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Billing for Services

When billing UnitedHealthcare Dual Complete for services provided, there are a few important things to keep in mind:

• Use the correct billing codes: When billing for services, it is important to use the correct billing codes to ensure that the claim is processed correctly. You will need to use the appropriate Healthcare Common Procedure Coding System (HCPCS) code for the service provided. If you are unsure which code to use, you can consult the Centers for Medicare & Medicaid Services (CMS) website or contact UnitedHealthcare Dual Complete for assistance.How to bill Unitedhealthcare dual complete
• Include the correct diagnosis code: In addition to the HCPCS code, you will also need to include the correct diagnosis code on the claim. This code indicates the medical condition for which the service was provided. Again, if you are unsure which code to use, you can consult the CMS website or contact UnitedHealthcare Dual Complete for assistance.

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• Submit claims on time: It is important to submit claims for services provided in a timely manner to ensure that they are processed and paid in a timely manner. UnitedHealthcare Dual Complete has specific deadlines for submitting claims, so be sure to check with them to ensure that you are submitting claims within the required timeframe.
• Follow up on claims: After submitting a claim, it is important to follow up to ensure that it is being processed and paid correctly. If there are any issues with the claim, you will need to address them in a timely manner to avoid delays in payment.

Payment for Services

UnitedHealthcare Dual Complete pays healthcare providers for services provided to their members. Payment rates are established by UnitedHealthcare Dual Complete and may vary depending on the type of service provided, the location of the service, and other factors. Payment may be made directly to the healthcare provider or to the patient, depending on the type of service provided and the provider’s agreement with UnitedHealthcare Dual Complete.

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Conclusion

Billing for services provided to patients with UnitedHealthcare Dual Complete can be complex, but following these guidelines can help ensure that claims are processed and paid correctly. Remember to obtain authorization before providing services, use the correct billing codes and diagnosis codes, submit claims on time, and follow up on claims to ensure timely payment. By following these guidelines, healthcare providers can ensure that they are providing high-quality care to their patients while also receiving payment for their services.