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How to Resubmit Denied Claims for Multiple Units of 88342 to UnitedHealthcare

UnitedHealthcare has finalized how it will reprocess denial of units of the immunohistochemistry service that exceeded one unit earlier this year. This process will affect all claims for 88342 that exceeded one unit with a date of services (DOS) on or after January 1, 2014 and processed by UnitedHealthcare on or before May 18, 2014. Pathologists seeking payment from UnitedHealthcare may use one of two options if they have not already resubmitted claims with a modifier 59 or 91, or with CPT code 88343, rather than 88342, to obtain reimbursement for the units denied. • Resubmission of Claims – Pathologists can resubmit their original unaltered claims on which only one unit of 88342 was paid. Pathologists should not make any changes to the original claim submitted unless the units exceed 13. For example, if 7 units were submitted on the original claim and payment for only one unit was made. All 7 units are to be resubmitted. These claims will not be denied as duplicates and will be processed in automated fashion by UnitedHealthcare without manual intervention. • Submission of Template through United’s Physician Advocate – This option is only available to pathologists who are participating providers with UnitedHealthcare. Using this method, practices must populate the insurer’s standard template of information and submit to their physician advocate. To secure the template, please contact your UnitedHealthcare physician advocate. If you do not know who your physician advocate is, search by entering your state at UnitedHealthcare’s website and find the Provider Relations contact. If there is no separate listing for Provider Relations in your state, you will use the Network Management contact.

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INDUSTRY NEWS TAGS: United Healthcare


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