WASHINGTON, D.C. (May 6, 2019)—Multiple providers have received word from UnitedHealthcare (UHC) local provider representatives that denial of PAP supply claims for DME providers is a system error at UHC. Only the UHC supply policy was updated on March 31, 2019, creating an issue with the claims processing system for DME claims. The provision of including PAP supplies should exclude DME providers using Place of Service 12 (Home).
AAHomecare has learned that providers are hearing mixed messages from UHC regarding appeals on these incorrect denials. Some providers have been told to submit denials as a claims project to UHC while others are being told not to resubmit and that UHC will be reprocessing the claims automatically.
The Association is still waiting for a response from national contracting at UHC to confirm this information and to obtain clarification on how providers should proceed for claims reprocessing. We will confirm the information from the national contracting team and let providers know as soon as we receive further guidance.
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