Optum denials

We constantly get medical records requests from Optum and they take 4-5 months to review and make a determination. It's making our UHC AR a complete disaster. They also just recently they sent us a list of over 100 claims for post-service review. Some of those claims were as far back as 2018. They decided to overturn quite a few of the payments and I have been appealing those for months... they just keep sending them back saying their decision was upheld, but with no real explanation. Nothing we can do about it because they will just offset future payments whether their post-service denials are valid or not. We've contemplated not even taking UHC anymore because it's such a nightmare with the Optum record requests.
 
I agree with the above. Its getting really bad. My coworker got ahold of a an email to someone in the UHC Corporate office. . She did some serious digging for that. Sent multiple letters and it actually got better for a while..they are slowly asking for more medical records again and its mainly the same few patients
 
They are asking for the records yes but, the simple thing I found is whenever they ask for records I use their portal and submit records in minute and right after 7 days we get their response either its denied or approved or whatever the status is.
 
Yes I am finding they are pending my claims for the records but don’t send a request to us, so I submit them thru there portal and I can track it
 
I have had issues where I have uploaded the documentation requested and mailed the information as well. One patient it took 6 months to finally receive payment because they asked for all the information to go to a 3rd address. I had to finally call and get a bit of a tone with the representative and told her I would not upload, fax or mail anything else for the claim. She provided an email address for just this one claim and we received payment in a week. Extremely frustrating.
 
Sure would like to see a class action attorney get involved. What they are doing is unreasonable. Now Optum is reviewing for Molina too. We joke (but it's not funny) that our UHC biller works full time for UHC just sending records.
 
Optum request records are a large majority of our claims. Optum also works on behalf of HealthFirst as well.
We submit all records request on UHC portal, it still can take several months for payment. We have encountered Optum approving codes and UHC denies, therefore no payment even if Optum approved it's ridiculous.
What can us providers do? It is really out of hand.
 
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