UNITED HEALTH CARE MULTIPLE PROCEDURE REDUCTION ERROR

on . Posted in Commercial Insurances

It has been recently discovered that United HealthCare is having a system wide issue in relationship to processing both therapy and modality charges.

From the information we gathered, all therapy claims billed with multiple units are being processed incorrectly by their computer system. The system is separating all charges with multiple units and breaking them down to individual line items.  At that point, the system is then breaking payment down based on the number of CPT codes, resulting in an incorrect multiple procedure reduction.

UHC does not have much information, they just became aware of the issue and do not expect it to be rectified until September or October 2013.

 For reference, the denial codes or Y1 and Y2.

(Y1)- This service line submitted with a single date of service and multiple units, or multiple dates of service and multiple units. Will be recoded to separate the dates and/or units.

(Y2)- For processing purposes this service line has been recoded (1) with an individual date of services. (2) with an individual unit, and/or (3) without a modifier.

Should a practice receive this denial, our staff has been instructed to call UHC and have the claim reprocessed.  UHC has already developed a “Claims Project Team” to handle the intake and reprocessing of these errors.

Please contact the office should you have any questions or concerns.

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