CurrentUCarePolicy UX24P0003A1

Home Health Services

Defines UCare's payment, billing, eligibility, and provider requirements for Home Health Services across applicable UCare products and the billing rules providers must follow.

Policy Summary

PayerUCare

PolicyHome Health Services

Policy CodePolicy UX24P0003A1

Change TypeTerminology clarification (Medicaid → Medical Assistance)

Effective DateJan 1, 2024

Next Review Date

Key ActionProviders must bill Notice of Admission (NOA) and follow Medicare, Medical Assistance, or IFP billing code sets as applicable.

SourceLink

POLICY UPDATE CHANGES

Updated 'Medicaid' terminology to 'Medical Assistance' in policy history.

Multipleproduct applicability listed

Medicare-certifiedeligible provider requirement

30-dayperiod-of-care billing

NOA requiredadmission notification

UB-04/837Ibilling form requirement

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Coverage and Eligibility

Product-specific coverage criteria

Eligibility and coverage vary by product; follow Medicare and/or Medical Assistance rules and IFP-specific criteria as described below.

Member must be actively enrolled in a UCare Medicare, Dually Integrated, or Individual & Family Plan (IFP) product.

Product-specific rules

Medicare: Services must meet Medicare coverage criteria and be delivered by a Medicare‑certified home health agency.
Dually Integrated (MSHO & Connect+Medicare): Follow both Medicare and Minnesota Medical Assistance criteria; members who do not meet Medicare requirements must meet Minnesota Medical Assistance coverage criteria.
Individual & Family Plans (IFP): Services covered when medically necessary, provided as rehabilitative, terminal, or maternity care, ordered by a physician, and included in a written home health care plan.

Provider requirement: eligible provider must be a Medicare‑certified Home Health Agency.

Home health services coverage and billing stance

Coverage and billing for home health services follow the listed revenue, modifier, and billing rules; providers must follow current authorization and notification requirements.

Claims must be submitted using required bill forms and formats (e.g., UB‑04 or electronic 837I) and follow period‑of‑care billing rules (30‑day periods).

See policy billing requirements for form and period guidance.

Use applicable Type of Bill and occurrence/condition/value code sets as required per product; PDGM revenue 0023 and HIPPS codes apply where indicated.

Providers must submit a Notice of Admission (NOA) and follow Medicare, Medical Assistance (MHCP) or IFP billing code sets as applicable.

Follow current prior authorization, notification, and threshold requirements; UCare updates these periodically and providers should reference the most current requirements.

Providers must identify member eligibility, contractual and regulatory guidance, and member Evidence of Coverage when submitting claims; Payment Policies are informational and do not supersede contracts or regulatory guidance.

Billing, Codes, and Periods of Care

Type of Bill (Medicare | Dually Integrated | Individual & Family Plans)mixed

032A	Notice of Admission - services under a plan of care
0329	Home Health Claim - services under a plan of care
0327	Replacement Claim - services under a plan of care
034x	Type of Bill for services not under a plan of care (034x indicates non-30-day bill types)

Location / Site-of-Service Modifiers (HCPCS Q-codes)HCPCSCovered

Q5001	Provided in patient's home/residence
Q5002	Provided in assisted living facility
Q5009	Provided in place not otherwise specified

PDGM and HIPPSRevenueCovered

0023	PDGM revenue code 0023 (home health) - applicable and billable per UCare policy
HIPPS	HIPPS code reporting required for PDGM payment grouping

Period of Care Length (30-Day Rules)

Bill 30-Day Periods of CareYes

Admit DateDate of admission submitted on the NOA for all periods until patient is discharged.

From Date & Thru DateFrom Date = first day of service under the 30-day period of care. Thru Date = either date of discharge, transfer, or 29 days after the From Date.

Prior Authorization Thresholds

Prior Authorization / NotificationUCare requires providers to follow current prior authorization and notification thresholds; requirements are updated periodically.

ReferenceThe most current prior authorization requirements can be found on the UCare provider authorization resources page.

Provider Billing & Notification Requirements

Prior Authorization

Prior Authorization Required

Prior Authorization Required. UCare requires prior authorization for specified home health services and any services that exceed established thresholds. Providers must obtain authorization before initiating services when such requirements apply to avoid claim denials or payment delays.

Prior authorization requirement applies where indicated on UCare authorization tables and plan-specific guidance.
Authorization must be obtained prior to service start for services flagged as prior auth on UCare lists.
Failure to obtain required prior authorization may result in claim denial or retrospective denial of coverage.

Billing Rule

NOA, Billing & Notification Actions

Notice of Admission (NOA) and Notification/Billing Actions. Providers must submit a Notice of Admission and follow payer/product-specific billing actions. Ensure accurate NOA submission and billing on the correct form to align with plan rules and avoid denials.

NOA is required for Medicare, Dually Integrated (MSHO & Connect+Medicare), and Individual & Family plans — submit per the payer-specific timing rules.
Bill on a UB-04 or 837I claim; use appropriate Type of Bill codes (e.g., 032A, 0329, 0327 for services under a plan of care; 034x for services not under a plan of care where applicable).
Medicare providers must bill specific G-codes and revenue codes; Medical Assistance providers must bill S & T-codes per MHCP Provider Manual when Medicare criteria are not met.
Admit Date on claims must match the admit date submitted on the NOA for all 30-day periods of care; bill 30-day periods of care and set From/Thru dates per payer rules.
Notify UCare per plan-specific notification rules when thresholds or utilization triggers are met to prevent payment issues.

Key Definitions

inv-09: Admission/Start of Care Date — Date of admission submitted on the NOA for all periods until discharge

Admission/Start of Care DateDate of admission submitted on the NOA for all periods until the patient is discharged

Application across productsAdmit Date definition is the same for Medicare, Dually Integrated, and Individual & Family Plans

Use on claimsAdmit Date is reported on the NOA and applies to all periods generated for the admission

inv-10: From Date — First day of service under the 30-day period of care

From DateFirst day of service under the 30-day period of care

ConsistencyFrom Date definition is identical across Medicare, Dually Integrated, and IFP products

Relationship to Thru DateFrom Date plus 29 days defines the maximum Thru Date if no earlier discharge or transfer occurs

inv-11: Thru Date — Date of discharge, transfer, or 29 days after the From Date

Thru DateEither the date of discharge, transfer, or 29 days after the From Date

Maximum periodThru Date may be set at From Date + 29 days when no earlier discharge or transfer occurs

Applies to all productsThru Date rule is the same for Medicare, Dually Integrated, and IFP

inv-12: Notice of Admission (NOA) — establishes patient and creates initial 30-day period; subsequent periods created by subsequent NOAs

NOA purposeEstablishes the patient and creates the initial 30-day period of care

Subsequent periodsAll subsequent periods of care in the admission are created by subsequent claims following the initial NOA

Requirement across productsNotice of Admission (NOA) is required for Medicare, Dually Integrated, and IFP

inv-13: Type of Bill — 4-digit code indicating base type of bill and sequence in period of care

DefinitionType of Bill is a 4-digit alphanumeric code: first three digits indicate base type of bill; fourth digit indicates sequence of this bill in the period of care

Examples (Medicare under plan of care)032A = Notice of Admission; 0329 = Home Health Claim; 0327 = Replacement Claim

Non-plan of care codes034x used for services not under a plan of care (Dually Integrated and IFP noted)

inv-14: Payment Policies (UCare) — Payment Policies are general references and do not supersede member-specific evidence or benefit documents

Purpose of Payment PoliciesGeneral reference resources to assist in administering payment for UCare benefits; intended for informational purposes

HierarchyMember-specific Evidence of Coverage, contracts, federal/state legislation, and regulatory guidance supersede Payment Policies in the event of a conflict

Not legal or coding advicePayment Policies do not constitute coding or compliance advice; providers remain responsible for accurate, compliant claims submission