Author Topic: united healthcare denial  (Read 4186 times)

catooch

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united healthcare denial
« on: July 22, 2008, 10:50:37 AM »
I have a question on united healthcare.  I just received a denial because they need a modifier for codes 97010, 97014, 98941.  What would be the appropriate modifier for these codes.  They said if the received this they will probably pay.

Thank you for your help.
Cathy, NY

Metrehab

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Re: united healthcare denial
« Reply #1 on: July 22, 2008, 11:55:59 AM »
I received a similar EOB from UHC in the past and I tried re-billing with Modifier-GP (services rendered under Outpatient Physical Therapy plan of care) unfortunately, UHC still did not pay.
I later found out that United Health Care does not pay for 97010 (hot/cold packs).
Also, they don't use 97014 anymore for E-Stim, they use is G0283.
As far as 98941, I am not familiar with that code, I work for a physical therapy clinic.
Anyway: Good luck.
Stacie Bacon



Michele

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Re: united healthcare denial
« Reply #2 on: July 22, 2008, 02:22:30 PM »
Hi Cathy,
   Is the UHC you are billing one of the Medicare Managed Care Plans?  If so, they require the AT modifier just like Medicare does.  They will only pay on the 98941 code (chiropractic manipulation) just like Medicare.

   If it is not a Medicare Managed Care Plan then I am not sure what modifier they would want.  I'm assuming your billing for a chiropractor so the GP wouldn't be appropriate but Stacie is right, UHC doesn't allow the 97010 and they use the G code for the 97014. 

    If the AT modifier is not what they are looking for then I would call your UHC provider rep and ask them for a little help.

Good luck
Michele
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corriejo

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Re: united healthcare denial
« Reply #3 on: July 22, 2008, 03:58:07 PM »
98941 is for manual manipulation (if you bill it with a 98943 you want to use modifier -51 on the 98943). As far as the 97... codes go, you want to modify them (both) with a -59, if you're billing along with the 98941.  hope that helps

kmoore

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Re: united healthcare denial
« Reply #4 on: November 09, 2008, 02:37:55 PM »
Ok I am new at medical billing and just signed my first chiropractic client.  One of his patients is a UHC patient and the following codes are on this dr's superbill CPT 98941, 98943 with modifier 51, 97010, 97012, 97014, & 97140 with modifier 59.  Does this mean that if I submit this with DX codes of 739.5, 739.3, 739.3, & 719.48 that it will be denied because of UHC not paying for 97 codes or is there a way I can submit this that it will be paid?
Thanks for the help
Kim

Michele

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Re: united healthcare denial
« Reply #5 on: November 09, 2008, 07:42:19 PM »
The only thing you can do is put the 59 modifier on.  Each UHC plan will have it's own guidelines, so you won't know what they are going to allow until submitting.  Without the modifier chances are good that they will bundle the services.  With the modifier, if they allow the codes, they will pay them separately.

Good luck
Michele
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kmoore

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Re: united healthcare denial
« Reply #6 on: November 10, 2008, 01:42:22 PM »
Michelle

I do have another question. He is also using code 98943 with modifier 51 and so I am referring that back to dx code 739.5 so I also need to put cpt code 97140 with modifier 59 to only that region also?

Thanks for the help.

Kim

Michele

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Re: united healthcare denial
« Reply #7 on: November 10, 2008, 07:30:38 PM »
That sounds correct!

Michele
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bdhobbs1

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Re: united healthcare denial
« Reply #8 on: November 11, 2008, 12:56:19 PM »
The main problem I am having with United Healthcare is that they are denying one of our patients stating we are out of network.  We have appealed and printed out the web page where it shows we are in-network and the appeal was denied.  We are currently in 2nd level appeal.

LW5689

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Re: united healthcare denial
« Reply #9 on: November 11, 2008, 07:18:51 PM »
I also recently received a denial but from medicare for a bill for physical therapy services because each procedure was missing a modifier.  What modifier(s) would i use for 97001, 97110 & 97112 & 97124 and 97250 with a diagnosis of 726.10 and 718.81.  Also, where can i find information on which modifiers to use in the future? thank you.

Michele

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Re: united healthcare denial
« Reply #10 on: November 11, 2008, 09:22:31 PM »
Is it possible that this is a separate part of UHC that you are not in network with?  What I mean is that sometimes you can be in network with an insurance carrier, but then they have a plan (or sometimes more than one) that is separate that you have to be par with in addition to the normal process.  We have had that happen.

I would call and get someone on the phone and ask them to verify if you are in network.  Then ask them to explain why, if you are in network, this claim was processed as if you were out of network.

Good luck

Michele
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Michele

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Re: united healthcare denial
« Reply #11 on: November 11, 2008, 09:25:12 PM »
All Medicare PT services require the GP modifier.  I am not sure where you can find info specifically for modifiers for PT codes.  We are actually working on such a product for different specialties, including PT.

Michele
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