1. N

    Question UHC - records request

    Has anyone had any luck with the new way UHC is requesting records for review? We've started to get requests for records, but now they're asking for manufacturer and model number of equipment used (bill for path lab), as well as manufacturer and brand info for testing supplies. If you've sent...
  2. M

    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...
  3. M

    Question 93228 and 93229 for UHC

    need help w/ finding what dx codes UHC will cover for 93228 and 93229 for COMMERCIAL policies. I can only find Medicare Advantage policies
  4. C

    NY - UHC Community Plan - CPT 20611 denial N425

    Question for anyone working in New York with emphasis on Orthopedics. We have recently started getting a noticeable influx in denials for CPT 20610 & CPT 20611. The denial reason listed is N425 (statutorily excluded). These are mostly knee injections with a diagnosis of osteoarthritis. Some...
  5. J

    Question Walking boot for ankle sprain denied as "routine"?

    Hello, We gave a patient a Walking Boot with the sprained ankle diagnosis and UHC is denying this as "not covered when considered routine". I am attempting to appeal this but I'm not sure why this would be even considered routine on their part? Has anyone had experience with this? Thank you !
  6. K

    Tobacco counseling billing

    UHC has new issue. They stated that tobacco use counseling covered under optim dx and recommended claim submission to rx. Does anyone already bill 99406 to rx? Thank you
  7. M

    95941/G0453 for UHC

    UHC is denying 95941 across the board. They have continued to tell us that we should refer to the Replacement Code Policy and utilize G0453. They have even updated their policy as of 01/01/2019 stating that 95941 will not be reimbursable when billed in the facility setting, which is how it is...
  8. A

    Independent Laboratory Billing Place of service code

    Hello! We are an independent lab running lcms(80307) and definitive(G0480-G0483) billing for urine collected at the facility the patient is receiving care from and sent to us. United Healthcare (UHC) just started denying our claims for box 24B and box 32. We have always billed with POS 81 in box...
  9. L

    Uhc & emg 95886 add on denial for max qty

    I have done everything I could to research this further. No matter how I bill this whether it is 1, 2, 3 or 4 units on line line item it denies. It does not do this for ANY OTHER carrier. This billing for up to 4 units per line item was acceptable until 2015- mid 2016, then late 2016-early 2017...
  10. MonarchMedBill

    What to do with patient balance?

    Hi guys! I work in a physician network for a set of physicians. One of our physicians did a bariatric consult. He did not sign/lock the progress notes until 117 days after the DOS. The insurance is UHC and our contract states timely filing is 95 days. In our office, this tends to happen...
  11. G

    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...
  12. N

    United Healthcare DME Supply Denials

    Our office is going crazy with these United Healthcare (Medicare Advantage Program) denials! I am hoping that someone else might be going through the same difficulty. We are a 3rd Party supplier/billing/coding company for DME supplies in nursing homes - generally when a patient finishes their...
  13. D

    Payer Frequency Edits-UHC

    Hoping someone can help me. I have been recently getting "Edits" (before claims reach payer) to detect any errors in billing/coding and payer edits referring to 26055 & 20550 from UHC/Oxford. Apparently only (1) unit per day is allowed as of 10/1/2016. This seems sort of silly as 20550 is a...
  14. T

    Colonoscopy -know this has probably

    I know this has probably come up several times, but here goes again. A pt came in Aug 2011 for colon w/biopsy 45380 at the age of 62 with UHC insurance and dx for diverticulitis. In 2008 he also had 45385 with UHC for dx blood in stool. He is now 67 and has Medicare and has no symptoms. The...
  15. J

    64493 dx coding for Medicaid MI UHC

    Medicaid MI UHC, Having trouble getting these paid for MMB, they keep saying dx issue, can anybody please help if you are getting these pd is Michigan ????