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UHC placing ‘pre-pay’ review on some Covid claims

Multiple labs we work with have recently received pre-payment records requests from UnitedHealthcare to support their Covid-19 testing. While UHC isn’t denying these tests for improper coding, the payments they’ve put on hold amount to nearly $1 million in some instances.

Despite our attempts to provide documentation, the payer has continued to hold these charges by claiming they haven’t received the paperwork or need additional records. When reaching out to Optum directly, our client was only informed that the review was, “based on the billing pattern submitted to insurance, including lab orders and the number or frequency performed for a patient.” 

As we try to gauge how widespread this issue is, please reach out to us directly if you’ve been impacted by similar practices. While it’s not surprising to see UHC use this tactic, it still feels like it’s going against the intent of the CARES Act and recent Biden Executive Order to broadly cover Covid testing for individual clinical assessment for the duration of the Public Health Emergency.

Interested in learning more about coding audits or improving your overall revenue cycle management? Contact us today for a free consultation.

 

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