We fought this and got varying information for what they wanted. They kept directing us to the NDC crosswalk but that did not define how UHC specifically wanted to see it on the claims. In some cases they were telling us the contrast came over as blank and on our side we show it was on the claim. That was determined to be an internal error at UHC. We finally received confirmation from an Optum Research, Outreach, and Specialization Team (ROS) Provider Relations employee (after 9 months of begging the reps to tell us what they needed) who told us the following:
This is how they need it billed
N4 11 dig NDC_ML_1
When we did this (sent corrected of course), many of the claims started processing without delay. They are also particular about the order of the CPT when they haven't been in the past....be sure any CPT codes with alpha characters in them are falling last. However, we still get random requests/denials and the claim is in the proper format. The only explanation I received for that was from an analyst (who you may decide to reach out to) who said:
I honestly feel it is an electronic processing error that happens from time to time with NDC. No root cause identified at this time.
Tracey Schultz
E&I Claims Bus Proc Analyst Sr
P:763-361-1469 tracey_schultz@uhc.com
Provider Relationship Insight and Service Model
Our United Culture. The way forward.
Good Luck! We had to start making decisions as to whether it was worth our time to keep fighting these or not. Also, heads up....when they reprocess the corrected claim, they split it and it changes your reimbursement which is another headache entirely. Don't know how they get away with this stuff, but even our appeal to the insurance commissioner was closed because UHC stated the issue was resolved. Which clearly it is not.
Mindy Smith
Billing Manager
Management Data Systems
3114 Lake St
Lake Charles, LA 70601
337-437-7681
866-437-7681
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