UnitedHealthcare recently transitioned its utilization management approach for all of its health plans from Milliman Care Guidelines to InterQual criteria. Learn how this change could have far-reaching impact on hospitals.
A policy that UnitedHealthcare was poised to roll out that would have allowed it to retroactively deny ED claims isn’t moving forward yet. But that doesn’t mean case managers shouldn’t prepare for the payer, or others, to implement such policies.
CMS announced another round of changes to its Bundled Payments for Care Improvement program recently and said that while participation thus far has been voluntary, it may become mandatory starting as early as 2024.