Author Topic: United HealthCare  (Read 1577 times)


  • Full Member
  • ***
  • Posts: 227
United HealthCare
« on: March 23, 2010, 02:35:57 PM »
Certain obstetrical claims denied by UnitedHealthcare will be reprocessed

The Kansas Medical Society recently notified the AMA that UnitedHealthcare was denying certain claims of physicians who only provide part of a patient's antepartum care as a result of spontaneous abortion, change of insurance or transfer to another practice. The circumstance was primarily affecting antepartum services using E&M codes and reported with modifier 25 on the same day as the ultrasound in which physicians would itemize the antepartum services by reporting E&M codes.

The AMA brought this problem to UnitedHealthcare's attention and learned that the denials were caused by a systems error that has since been corrected. According to UnitedHealthcare, physicians who received these claim denials for services rendered on or after Aug. 17, 2009 do not need to appeal or refile their claims. Instead, UnitedHealthcare will reprocess these claims. Physicians should receive corrected payments by the end of May. If you received one of these denials and do not receive a reimbursement for the denial, please contact the AMA at so that we can address this issue with UnitedHealthcare.

Claims submitted to UnitedHealthcare on or after Mar. 15, 2010 will be processed according to the posted reimbursement policy available at The AMA commends UnitedHealthcare for its quick response in addressing this issue.
Michael A. Reynolds, CPC, CCP-P, CPMB, OS
Project Manager
Corporate Compliance
Sharp HealthCare