Results 1 to 3 of 3

Uhc

  1. Question Uhc
    Medical Coding Books
    Why is UHC requesting MR for every single claim? Is this allowed?

  2. #2
    Default
    Yes it is allowed to request records, even all of them. The reason might vary, but basically the provider has been selected for an audit. The Health Plan can audit records based on a number of criteria such as billing patterns, reports of "suspicious" activity, repeatedly sending in a corrected claim, or any number of other criteria. I would recommend reaching out to the person/department requesting the records and asking questions. In my position I am the one requesting records and it only done for specific reasons. But Yes it is allowed and depending on the payer they can go back 3 years at least.
    EVELYN KIM , MBA, CFE, CPC, CPMA,CRC, AAPC Fellow
    Manager, SIU

  3. #3
    Default
    Some payers and providers do include limits on medical records requests in the contracts or network participation agreements. If you are in-network, you might want to review your contract and see whether or not this is the case. If it's not, you might want to consider having it added to the contract as a condition of renewing your participation.

Similar Threads

  1. Uhc/medicaid?
    By MP555 in forum General Discussion
    Replies: 1
    Last Post: 08-03-2017, 01:28 PM
  2. UHC and X-rays
    By alk@APS in forum Billing/Reimbursement
    Replies: 4
    Last Post: 07-28-2016, 08:13 AM
  3. UHC Denial
    By mshell71@tx.rr.com in forum Orthopaedics
    Replies: 1
    Last Post: 11-04-2015, 03:54 PM
  4. 33208 and UHC
    By Griffith_Tiffany in forum Cardiology
    Replies: 2
    Last Post: 12-19-2014, 10:47 AM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
  •  
Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?

Login

Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.