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Wiki UHC Denials

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shellycoste

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Hi everyone! I work Inpatient Coding denials. Anyone have issues especially with UHC for diagnosis Acute Respiratory Failure where the payor is saying "payor specific criteria" not met. Example: Patient meets criteria for respiratory failure with diagnostic criteria, symptomatic and required supplemental oxygen (several references support this. Pinson & Tang, Medscape, etc). but the payor denies b/c they didn't meet their specific criteria (example: UHC required 5L of more of oxygen to support resp failure, regardless of the other criteria. No medical literature or references say this is a requirement). Driving me insane!
 
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