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</o:shapelayout></xml><![endif]--></head><body lang=EN-US link="#0563C1" vlink="#954F72" style='word-wrap:break-word'><div class=WordSection1><div><div><div><div><div><div><div><p class=MsoNormal align=center style='text-align:center'><span style='font-size:9.5pt'><img width=540 height=163 style='width:5.625in;height:1.6979in' id="m_-7835614069456891615gmail-m_-8812551497387718317gmail-m_-680625089083050367m_-4761171347054414624m_3707413379897925782Picture_x0020_1" src="cid:image001.jpg@01D76436.17F56A10"></span><span style='font-size:9.5pt'><o:p></o:p></span></p><p class=MsoNormal><span style='font-size:9.0pt;font-family:"Arial",sans-serif'> </span><span style='font-size:9.5pt'><o:p></o:p></span></p><div style='margin-left:15.0pt;margin-top:7.5pt;margin-right:15.0pt;margin-bottom:7.5pt' id="m_-7835614069456891615gmail-m_-8812551497387718317gmail-m_-680625089083050367m_-4761171347054414624m_3707413379897925782content"><div style='border-top:solid #7F7F7F 1.0pt;border-left:none;border-bottom:solid #7F7F7F 1.0pt;border-right:none;padding:4.0pt 0in 4.0pt 0in'><p class=MsoNormal><b><span style='font-size:9.5pt;font-family:"Arial",sans-serif;color:#7F7F7F'>June 17, 2021</span></b><span style='font-size:9.5pt'><o:p></o:p></span></p></div><div style='margin-top:11.25pt;margin-bottom:11.25pt'><p class=MsoNormal><b><span style='font-size:12.5pt;font-family:"Arial",sans-serif;color:#DF0009'> </span></b><span style='font-size:9.5pt'><o:p></o:p></span></p><p class=MsoNormal><b><span style='font-size:12.5pt;font-family:"Arial",sans-serif;color:red'>UnitedHealthcare delays rollout of emergency department facility review program</span></b><span style='font-size:9.5pt'><o:p></o:p></span></p><p class=MsoNormal><span style='font-size:9.5pt'><o:p> </o:p></span></p><p class=MsoNormal><a href="https://www.cmadocs.org/newsroom/news/view/ArticleId/49392/UnitedHealthcare-delays-rollout-of-emergency-department-facility-review-program"><span style='font-size:9.5pt;font-family:"Arial",sans-serif;color:#1155CC'>CMA</span></a><span style='font-size:9.5pt'><o:p></o:p></span></p><p class=MsoNormal style='margin-right:15.7pt'><span style='font-size:9.5pt;font-family:"Arial",sans-serif'> </span><span style='font-size:9.5pt'><o:p></o:p></span></p><p class=MsoNormal style='margin-right:30.7pt'><span style='font-size:9.5pt;font-family:"Arial",sans-serif'>Based on concerns from numerous medical societies and physician organizations, UnitedHealthcare (UHC) has delayed the rollout of a its planned emergency department facility review program. The new <a href="https://www.uhcprovider.com/en/resource-library/news/2021-network-bulletin-featured-articles/0621-ed-facility-commercial-claims.html" target="_blank"><b>program</b></a>, originally scheduled for implementation on July 1, 2021, would have implemented a post-service review of emergency department (ED) facility claims for commercial enrollees to determine if the visit was emergent in nature.</span><span style='font-size:9.5pt'><o:p></o:p></span></p><p class=MsoNormal style='margin-right:30.7pt'><span style='font-size:9.5pt'><o:p> </o:p></span></p><p class=MsoNormal style='margin-right:30.7pt'><span style='font-size:9.5pt;font-family:"Arial",sans-serif'>According to UHC the rollout has been delayed at least until the conclusion of the national public health emergency period.</span><span style='font-size:9.5pt'><o:p></o:p></span></p><p class=MsoNormal style='margin-right:30.7pt'><span style='font-size:9.5pt'><o:p> </o:p></span></p><p class=MsoNormal style='margin-right:30.7pt'><span style='font-size:9.5pt;font-family:"Arial",sans-serif'>Under the new ED facility review program, claims determined to be non-emergent in nature, coverage could be denied retroactively based on numerous factors including the following:</span><span style='font-size:9.5pt'><o:p></o:p></span></p><ul style='margin-top:0in' type=disc><li class=MsoNormal style='margin-right:30.7pt;mso-list:l0 level1 lfo1'><span style='font-size:9.5pt;font-family:"Arial",sans-serif'>The patient’s presenting problem<o:p></o:p></span></li><li class=MsoNormal style='margin-right:30.7pt;mso-list:l0 level1 lfo1'><span style='font-size:9.5pt;font-family:"Arial",sans-serif'>The intensity of diagnostic services performed<o:p></o:p></span></li><li class=MsoNormal style='margin-right:30.7pt;mso-list:l0 level1 lfo1'><span style='font-size:9.5pt;font-family:"Arial",sans-serif'>Other patient complicating factors and external causes<o:p></o:p></span></li></ul><p class=MsoNormal style='margin-right:30.7pt'><span style='font-size:9.5pt;font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal style='margin-right:30.7pt'><span style='font-size:9.5pt;font-family:"Arial",sans-serif'>Claims determined to be non-emergent would be subject to a “no coverage” or “limited coverage” outcome depending on the enrollee’s benefit plan. Providers wishing to dispute the non-emergent determination would be required to submit an attestation that the visit met the definition of an emergency consistent with the prudent layperson standard. However, UHC reserves the right to still request medical records for claims review, even if an attestation had been submitted.<o:p></o:p></span></p><p class=MsoNormal style='margin-right:30.7pt'><span style='font-size:9.5pt;font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal style='margin-right:30.7pt'><span style='font-size:9.5pt;font-family:"Arial",sans-serif'>The California Medical Association (CMA) along with many other state and specialty societies, signed on to an American College of Emergency Physicians <a href="https://www.cmadocs.org/Portals/CMA/files/public/United%20sign-on%20letter%20ED%20policy%2006.16.2021.pdf" target="_blank"><b>letter</b></a> expressing grave concerns about the retroactive denial of coverage for emergency care. While CMA appreciates the temporary delay in implementing this program, we are urging UnitedHealthcare to rescind it permanently, and believe there is a better way to ensure that patients access the right care, in the right place, at the right time.<o:p></o:p></span></p><p class=MsoNormal style='margin-right:30.7pt'><span style='font-size:9.5pt;font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal style='mso-margin-top-alt:0in;margin-right:45.7pt;margin-bottom:11.25pt;margin-left:0in'><span style='font-size:9.5pt;font-family:"Arial",sans-serif'>For questions regarding the new program, contact UHC Provider Services at (877) 842-3210.<o:p></o:p></span></p><p class=MsoNormal style='mso-margin-top-alt:0in;margin-right:45.7pt;margin-bottom:11.25pt;margin-left:0in'><span style='font-size:9.5pt;font-family:"Arial",sans-serif'><o:p> </o:p></span></p></div><p class=MsoNormal><span style='font-size:9.5pt;font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal><span style='font-size:9.5pt;font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal><span style='font-size:9.5pt;font-family:"Arial",sans-serif'> </span><span style='font-size:9.5pt'><o:p></o:p></span></p><p class=MsoNormal><strong><span style='font-size:9.5pt;font-family:"Arial",sans-serif'>Brian Potts</span></strong><b><span style='font-size:9.5pt;font-family:"Arial",sans-serif'> MD, MBA</span></b><span style='font-size:9.5pt;font-family:"Arial",sans-serif'><br>Managing Editor, CAL/AAEM News Service</span><span style='font-size:9.5pt'><o:p></o:p></span></p><p class=MsoNormal><span style='font-size:9.5pt'> <o:p></o:p></span></p></div><p class=MsoNormal style='background:#D9D9D9'><span style='font-size:9.0pt;font-family:"Verdana",sans-serif;color:black'>Contact us at: </span><span style='color:black'><a href="mailto:calaaem.news.service1@gmail.com" target="_blank"><span style='font-size:9.0pt;font-family:"Verdana",sans-serif;color:#1155CC'>calaaem.news.service1@gmail.com</span></a></span><span style='font-size:9.0pt;font-family:"Verdana",sans-serif;color:black'><br><br>For more articles, visit our </span><span style='color:black'><a href="https://www.aaem.org/get-involved/chapter-divisions/calaaem/news-service" target="_blank"><span style='font-size:9.0pt;font-family:"Verdana",sans-serif;color:#1155CC'>archives</span></a></span><span style='font-size:9.0pt;font-family:"Verdana",sans-serif;color:black'>. <br><br></span><span style='color:black'><a href="mailto:somcaaem@uci.edu" target="_blank"><span style='font-size:9.0pt;font-family:"Verdana",sans-serif;color:black;text-decoration:none'>To</span></a><a href="https://maillists.uci.edu/mailman/listinfo/calaaem" target="_blank"><span style='font-size:9.0pt;font-family:"Verdana",sans-serif;color:#0070C0;text-decoration:none'> </span><span style='font-size:9.0pt;font-family:"Verdana",sans-serif;color:#1155CC'>unsubscribe</span></a></span><span style='font-size:9.0pt;font-family:"Verdana",sans-serif;color:black'> from this list, visit our mail server.<br><br>Copyright (C) 2021. The California Chapter of the American Academy of Emergency Medicine (CAL/AAEM).</span><span style='font-size:9.0pt;color:black'> </span><span style='color:black'><a href="http://www.calaaem.org/" target="_blank"><span style='font-size:9.0pt;font-family:"Verdana",sans-serif;color:#1155CC'>http://www.calaaem.org</span></a></span><span style='font-size:9.0pt;font-family:"Verdana",sans-serif;color:black'>. All rights reserved.<br><br>CAL/AAEM, a nonprofit professional organization for emergency physicians, operates the CAL/AAEM News Service solely as an educational resource for physicians. Dissemination of an article by CAL/AAEM News Service does not imply endorsement, agreement, or recommendation by CAL/AAEM News Service, CAL/AAEM, or AAEM.</span><span style='font-size:9.5pt'><o:p></o:p></span></p><p class=MsoNormal style='background:#D9D9D9'><span style='font-size:9.5pt'><o:p> </o:p></span></p><p class=MsoNormal style='background:#D9D9D9'><b><span style='font-size:9.0pt;font-family:"Verdana",sans-serif;color:black'>Follow CAL/AAEM on Facebook and Twit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