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Please review your claim submission process

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PLEASE REVIEW YOUR CLAIM SUBMISSION PROCESS

Our review of your recent claim denials found a number of claims that were
denied due to missing information, modifiers or incorrect coding. Please review
the information below for details.


OCULAR SCREENING CLAIM DENIALS DUE TO INCORRECT PROCEDURE CODE

Ocular screening claims (CPT code 99174 and 99177) denied with remark code 08
indicate they were not billed with the correct diagnosis code for a patient age
6 and older, which is required for the claim to be considered for reimbursement.
The Omnibus Codes – Commercial Medical Policy outlines more than 200 CPT/HCPCS
procedure codes, including the full coverage rationale and clinical evidence
applicable to each of the listed procedures.


ACTION NEEDED

Please review the policies for more information. Then, adjust your claims
submission process as needed to reflect the requirements.

You may submit a corrected claim within 1 year of the original explanation of
benefits (EOB) or provider remittance advice (PRA) that outlined the claim
denial. The correction(s) submitted should represent a complete replacement of
the previous claim and include the appropriate modifier for any claim that has
been denied. Please use the correct frequency code or bill type to indicate it
is a replacement claim or clearly mark it with the word “corrected”.


QUESTIONS?

Please email the appropriate network team noted below, based on where your
practice is located:

 * Northeast region: northeastprteam@uhc.com (CT, DC, DE, MA, MD, ME, NH, NJ,
   NY, PA, RI, VA, VT, WV)
 * Southeast region: southeastprteam@uhc.com (AL, AR, FL, GA, LA, MS, NC, PR,
   SC, TN)
 * Central region: centralprteam@uhc.com (IA, IL, IN, KS, KY, MI, MN, MO, ND,
   NE, OH, OK, SD, TX, WI)
 * West region: westprteam@uhc.com (AK, AZ, CA, CO, HI, ID, MT, NM, NV, OR, UT,
   WA, WY)
 * National: npr@uhc.com (Groups or health systems with location in
   multiple regions)

Insurance coverage provided by or through UnitedHealthcare Insurance Company or
its affiliates. Health plan coverage provided by UnitedHealthcare of Arizona,
Inc., UHC of California DBA UnitedHealthcare of California, UnitedHealthcare
Benefits Plan of California, UnitedHealthcare of Colorado, Inc.,
UnitedHealthcare of the Mid-Atlantic, Inc., MAMSI Life and Health Insurance
Company, UnitedHealthcare of New York, Inc., UnitedHealthcare Insurance Company
of New York, UnitedHealthcare of Oklahoma, Inc., UnitedHealthcare of Oregon,
Inc., UnitedHealthcare of Pennsylvania, Inc., UnitedHealthcare of Texas, Inc.,
UnitedHealthcare Benefits of Texas, Inc., UnitedHealthcare of Utah, Inc.,
UnitedHealthcare of Washington, Inc., Optimum Choice, Inc., Oxford Health
Insurance, Inc., Oxford Health Plans (NJ), Inc., Oxford Health Plans (CT), Inc.,
All Savers Insurance Company, or other affiliates. Administrative services
provided by OptumHealth Care Solutions, LLC, OptumRx, Oxford Health Plans LLC,
United HealthCare Services, Inc., or other affiliates. Behavioral health
products provided by U.S. Behavioral Health Plan, California (USBHPC), or its
affiliates.

PCA-1-22-03476-PO-EM_10272022

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