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UNITED HEALTHCARE CLAIMS

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johmarcel:
I was wondering you ever had to do some appeals with difficult insurance payors such as United Healthcare? Have you ever had a situation with this insurance company taking submitted claims and recoding them, such as:
a claim submitted for $1750.00 for dos of 11/2/09-11/30/09, and united healthcare would  take this claim and take the dates of services and list them separately without permission from the provider. Is this legal? and can they do this?

Anand:
Hello,

  I dont see that as a re-coding - sometimes the insurance would split the line items and process the claim. My only question is  - Did you call UHC and enquire what happened, I am sure you will get better response. Thanks

Michele:
If you submit the claim showing 29 units for visits from 11/2-11/30 and the insurance company splits them out to 29 separate lines, that's not recoding, that splitting the units out to individual lines.  Actually, most carriers would require that you bill them that way.  In any case, even if they split it out to the 29 lines, they should process the same as if it was grouped together.  If you don't agree with the payment then you should call to inquire as to the way they processed it.

Michele

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