UnitedHealthcare claims this protocol is not a pre-certification, pre-authorization program or medical necessity determination. A notification number must be obtained in accordance with the Cardiology Notification process prior to perform EP implant procedures. Failure to complete the notification process will result in an administrative denial. All procedures require notification regardless if they are elective or emergent. (Emphasis mine)Cardiology Notification process? WTF? Where, exactly, do we place this "notification number" in patient patient's chart? In their operative report?
Prior notification may be obtained online, by telephone or fax:
■Online: UnitedHealthcareOnline.com (User ID and password are required)
■Telephone: +1 (866) 889-8054
■Fax: 1 (866) 889-8061
I can see it now as P waves are dancing across the screen:
"Hold on there, Ms. Smith! Just trying to place this temporary pacing wire... Um, give me a minute, okay.... Uh, which insurance do you have?.... er, please ma'am, don't talk right now - I might hit your lung.... It wouldn't be Unitedhealthcare, would it? Wait, don't talk.... okay, which one? Yes? Does anyone have UnitedHealthcare's Cardiology Pay-to-Play number???..."And will the service will be 24/7/365?
"Okay, Ms. Smith... Ms. Smith????... Ms. Smith???...."
(gurgling noises hard in background)
Of course not!
If notification is required on an emergent basis or notification cannot be obtained because it is outside of UnitedHealthcare’s normal business hours, the service may be performed, and notification can be requested retrospectively. Retrospective Notification requests must be made within 14 calendar days of the service. Rendering physicians should follow the same notification process outlined for a standard request. Documentation must include an explanation as to why the procedure was required on an emergent basis or why notification could not be obtained during UnitedHealthcare’s normal business hours. If a claim is submitted prior to the Retrospective Notification Process being completed, it will receive an automated denial for lack of notification; however, the claim will be reprocessed if Retrospective Notification is received within 14 calendar days of the date of service, and it meets criteria as an emergent procedure.Just think how many hours upon hours of doctors' time will now be spent holding online waiting for a college dropout to tell us our notification number!
Damn, what a waste of resources.
This is our "guidelines" for care are now mandates for patient care and will be used against us in our new era of health care reform.
Deviate from them and your patient will pay...
... and pay dearly.
Addendum: Dr. John Mandrola, another EP, shares a similar story, even before these new mandates go into effect.