denials uhc

  1. A

    Wiki UHC Community Plan of NJ - billing of NPs, PAs, or other mid levels?

    How is everyone getting reimbursed by UHC Community Plan of New Jersey for nurse practiioner or physician assisant claims? For context, we are OBAT substance abuse via telehealth. We bill e/ms with telehealth modifiers. I tried GT and 95 modifiers on the claims per UHC telehealth modifier policy...
  2. K

    Wiki UHC Denying all claims as OON but Provider is IN network

    I own a small medical billing company. I have providers in all different specialties. Since the beginning of 2025, I have had many UHC claims come back and processed as out of network for multiple clients but these providers are all in network. I have uploaded information show their network...
  3. J

    Wiki UHC denial Reverse total shoulder

    Hi Everyone-- I coded the OP note below as 23472 and 23405. UHC is stating that the CPT codes billed are incorrect. I feel like I am going crazy with UHC. Am I missing something? If someone could quickly review. We have have appealed twice. Procedure: 1. Right reverse total shoulder...
    • jhaleycoder
    • Thread
    • denials uhc optum ortho help orthopedic coding shoulder arthroplasty shoulder coding
    • Replies: 4
    • Forum: Orthopaedics
  4. P

    Wiki UHC Denials for UTiD

    We are getting denials from UHC/Wellmed insurance stating that CO-96 - Non-covered charge(s). At least one Remark Code must be provided, N35 - Program integrity/utilization review decision, these are the billing CPT codes 87798,87481,87556,87640,87653,87651,87563,87086. We have tried with...
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