A helpful grid outlining when a corrected claim, void, resubmittal/adjustment are done is now available for reference. Please follow the link for additional details.
PCG has found that there has been an increase in incorrect use of Medicaid delay reason codes. It is the responsibility of the providers to utilize the appropriate delay reason codes. Delay reason codes are used on claims billed beyond Medicaid’s 90-day initial filing limit or when resubmitting claims with updated information within the 60-day resubmission window of claims denied or rejected. Please follow the link for additional details and guidance.
If your Medicaid claims were denied due to the expiration of the filing time limit (code 29), and you used delay reason code 15 (related to a natural disaster or state of emergency), the Department of Health (DOH) can review them manually.
To learn more about why code 15 was valid for your claims, please contact the Bureau of Medical Review's Pended Claims Unit at 1-800-342-3005 (select option 3).
PCG has found that there has been an increase in ongoing rejections from Medicaid due to providers utilizing invalid or expired ICD-10 codes. Please follow the link for additional details and guidance.
Attention providers: United Healthcare will no longer accept paper claim reconsiderations or post-service appeal submissions starting February 1 2023. These will need to be submitted electronically.
Your electronic submission options
1. UnitedHealthcare Provider Portal: Submit under Claims & Payments.
Need help? See the Online Reconsiderations and Appeals interactive guide for a step-by-step guide on how to submit reconsiderations and appeals electronically.
2. Application Programming Interface (API): Consider submitting reconsiderations and appeals through API. Data can be distributed to your practice management system or any application you prefer. API requires technical programming between your organization and UnitedHealthcare, so advanced planning is required.
See the full article, please follow the link.