Medical Billing Forum
Billing => Billing => : aajkaal January 11, 2019, 02:04:27 PM
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UHC, as known world-wide has the poorest customer service, so please help. Thanks in advance.
I got paid 2 out of the 3 cpt codes I billed and now I have to change the one which I was not paid and resubmit. Shall I show payment recvd on two when submitting the 3rd one or send them all 3 not-paid - they will mark the 2 duplicate and pay me for the changed 3rd one. UHC Medicare advantage plan rep said they follow Medicare guidelines for coding. So what should I do ?
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If you are submitting the claim as a corrected claim then you should use the UHC reconsideration request form & attach a claim showing all three charges (CPT codes). Even though the two are paid, they should be on the corrected claim so that they don't think that you are now saying those were not supposed to be on the claim.
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I am sending claims electronically, so I cannot attach UHC reconsideration request. Any alternate ?
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If you are submitting it as a corrected claim then you should be using the UHC reconsideration form. Some insurance carriers allow corrected claims to be submitted electronically, but there is no way to indicate what you are changing and why so I guess if it were me I would be looking at why I'm changing the third code. If I felt it needed an explanation I would be doing it on paper with the form. If you feel that no explanation is needed you can submit as a new claim. Personally I would resubmit all three charges because if you are changing the third code the new code may require a modifier on one of the other two codes that were already processed, etc. In many cases when multiple codes are submitted on the same day they 'interact' with each other. Submitting one line individually could interfere with that 'interaction'.