Policies, Protocols, and Administrative Guidelines

Changes to Pre-Certification Guidelines for Polysomnography and Portable Monitoring for Sleep Related Breathing Disorders

Neighborhood Health Partnership is pleased to announce a change to their Medical Policy for sleep testing to enhance the evaluation and management services for patients with possible and confirmed obstructive sleep apnea (OSA). The revised policy manages access to home-based testing for OSA and for patients who require positive airway pressure therapy (PAP) home titration or self-adjusting treatment with auto-adjusting positive airway pressure (APAP).

This change will go into effect on October 1, 2011. An article advising providers of this change was included in the July 2011 (Vol 44) Network Bulletin. In addition, letters were sent during the week of June 27 to advise of this change.

Please review the revised Medical Policy for complete details on the documentation requirements and evaluation criteria for a determination of coverage for these services.

Polysomnography and Portable Monitoring for Sleep Related Breathing Disorders

Sleep Test - Patient Information Worksheet.

As always, you may initiate a pre-certification request through Neighborhood Health Partnership’s Utilization Management Department by calling, 800-550-5568 or, by fax to 800-731-2515 or 800-729-1574.

To help facilitate diagnosis using home sleep testing when appropriate, UnitedHealthcare has contracted with VirtuOx, an Independent Diagnostic Testing Facility (IDTF), to perform home sleep testing nationwide, along with locally contracted sleep specialists. Additional information is available at www.virtuox.net, or by calling 877-337-7111.

Neighborhood Health Partnership is contracted with Advocare Health Alliance for APAP devices. You may contact Advocare Health Alliance Customer Services Department in Miami-Dade County: 305-728-2747 or outside Miami-Dade County: 866-374-4326.