optum

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    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. 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
  3. J

    Wiki Back to see if the message board can help me again.

    I had an AAPC member help me land my first job in coding with CSI Companies by using this message board and I am extremely appreciative of that member. I have been a Risk Adjustment medical coder with Optum/UNH for the past 8 years. I am interested in pursing a position that pays $60,000+ I...
  4. A

    Wiki HELP!!! OPTUM - PAIN MANAGEMENT INJECTION DENIALS

    We have been having an issue of getting our pain management injections paid by Optum Lifeprint (ex. ESI, MBB, RFA, Joint, etc). Everytime we bill an injection, we get a denial stating that Optum requires a drug code to be associated with the claim. And here is the kicker: we don't buy the drugs...
  5. T

    Wiki United Healthcare/Optum OON changes effective 7/1/21

    Hello, The SUD facility I work for is OON with this payer and was recently made aware that effective 07/01/2021 United Healthcare/Optum updated its coverage of OON benefits to exclude coverage of OON services provided outside of the member's "service area" Oddly the written announcement was...
    • TashaCPB
    • Thread
    • 07012021 benefits coverage coverageupdates fullyinsuredplans membersservicearea oon optum outofnetwork united healthcare
    • Replies: 0
    • Forum: Billing/Reimbursement
  6. M

    Wiki 96127 and UHC

    Hello, we are able to get reimbursement from every major healthcare provider. We are at a loss with United healthcare though. I was wondering if I can get any feedback from somebody on how they get reimbursement for the 96127 CPT code. Not sure if it has something to do with the diagnosis or a...
  7. G

    Wiki United Healthcare/Optum Claims Review

    Just wondering if anyone else is getting claims reviewed through Optum that are completely inaccurate? Procedures that are clearly in the operative notes denied, separate procedures bundled inappropriately, procedures denied as "size of defect" not documented although its right in the operative...
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