• If this is your first visit, be sure to check out the FAQ & read the forum rules. To view all forums, post or create a new thread, you must be an AAPC Member. If you are a member and have already registered for member area and forum access, you can log in by clicking here. If you've forgotten the password it can be reset on our sign in section by entering your registered Email Address or Username here. To start viewing messages, select the forum that you want to visit from the selection below..

Wiki Any Advice?

Create Wiki
S

StacyGalloway

Networker
Messages
81
Location
Calera, AL
Best answers
0
UHC Community Care is auditing charts from 2020-2023. They have determined through their audit that some of the charges that we submitted do not support the level of CPT that was billed. I am under the understanding that we cannot even go back and submit corrected claims to only have a portion of the $ returned due to the fact that it is past any timely filing requirement. #1 Is it common practice for an audit company, ADVIZE, to request payment back to them? Usually we have seen payment sent back in the form of recoupment. #2 How far back and insurance companies go when auditing? Any help/advice would be appreciated.
 
It is payors' discretion's process. But you still have an option to dispute legit services.
"I am under the understanding that we cannot even go back and submit corrected claims to only have a portion of the $ returned due to the fact that it is past any timely filing requirement. #1 Is it common practice for an audit company"
Here is how:
1) Correct claim and resubmit; communicate your process with provider representative;
2) Claim will be denied for TF;
3) Contact IC's provider representative to waive TF denial for corrected claim and provide all necessary supportive documentation and your mitigation steps timely taken.

Kindest regards,
 
You must log in or register to reply here.
Top