# United Healthcare



## tpayne129 (May 9, 2019)

I was just wondering if other practices were getting numerous medical records requests from UHC before payment.


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## petroskek (May 13, 2019)

We are. It just started recently.


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## depaul (Jun 12, 2019)

We have been for a couple years. I'm in Colorado.


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## Pathos (Jun 13, 2019)

What is the reasoning for the medical record requests? Audit?


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## RDK720 (Jun 13, 2019)

Probably an Audit. We had to submit medical records of certain providers to Atlanta, GA. The rest within the Specialty/Group were paid with no issues.


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## Pathos (Jun 13, 2019)

Most of the health plans are currently going through a big CMS audit on their Risk Adjustment this year, and they are going to need medical records to support their Risk Adjusted diagnoses. This is probably why UH is asking for medical records.

Could be an other audit, but this one is especially bigger than previously.


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## RebeccaB (Jun 14, 2019)

a crazy amount..takes so much time


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## kjb11 (May 7, 2020)

Has anyone been release from the audit


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## camillecoder@hotmail.com (May 7, 2020)

Unreasonable amount of records requests.  Has been increasing over the past couple of years.  It's frustrating because sometimes UHC wants the records to go directly to UHC, sometimes it wants the records to go to Optum, and very frequently both UHC and Optum deny ever receiving the documentation.


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## RebeccaB (May 7, 2020)

lots & lots of claim denials also..just for fun


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## klapetri@ilovemygyn.com (May 29, 2020)

OB/GYN-New York
Back in January 2020, I attended UHC town hall meeting. Not much came out of it, several different physician groups also complaining the amount of medical records request UHC has been sending.

Many physicians complaining, UHC  denies claim all together for records don't support codes billed...
This has been going on for about a year with us. And other specialties as well...


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## RebeccaB (Jun 1, 2020)

klapetri@ilovemygyn.com said:


> OB/GYN-New York
> Back in January 2020, I attended UHC town hall meeting. Not much came out of it, several different physician groups also complaining the amount of medical records request UHC has been sending.
> 
> Many physicians complaining, UHC  denies claim all together for records don't support codes billed...
> This has been going on for about a year with us. And other specialties as well...


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## RebeccaB (Jun 1, 2020)

Our practice also (urology)  a million record requests ,claim denials..lots of them for records do not support services billed..often multiple denials on the same claim and then having to do at least one if not more appeal...its completely ridiculous and takes so much time


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## klapetri@ilovemygyn.com (Jun 3, 2020)

agreed, this has been very frustrating for us. UHC is not consistent. We can not identify accurate reason why records are requested.


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## Orthocoderpgu (Jun 3, 2020)

I don't know why UHC even asks for medical records since it's been my experience that they can't even read them. I've coded for orthopedic surgeons all over the western states and have seen both terrible and fantastic documentation. UHC denied a surgical procedure stating that it was not documented in the OP note, when it was actually documented very well. I don't know who is reading the documentation on their side, but they are not experienced. I hate to see us lose money just because someone at UHC can't read an OP.


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## jeskla (Aug 24, 2020)

I work for a mixed specialty group- mostly ortho surgery -and Optum has been requesting almost all of our notes for the past year. Appealing doesn’t help, they lose the appeals or uphold their original decision.


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## klapetri@ilovemygyn.com (Nov 17, 2020)

any update anyone?

We're still receiving medical record request for at least 55% of our claims. 
Does anyone have a resolution?


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## SharonCollachi (Nov 17, 2020)

I have a feeling they're trying to harrass you into dropping out of their network.  I have zero data to back this up though.


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## cherene (Nov 23, 2020)

Orthocoderpgu said:


> I don't know why UHC even asks for medical records since it's been my experience that they can't even read them. I've coded for orthopedic surgeons all over the western states and have seen both terrible and fantastic documentation. UHC denied a surgical procedure stating that it was not documented in the OP note, when it was actually documented very well. I don't know who is reading the documentation on their side, but they are not experienced. I hate to see us lose money just because someone at UHC can't read an OP.


Hoping you filed an appeal?  UHC/Optum same organization and I have worked with them, NOT FUN


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## Orthocoderpgu (Nov 23, 2020)

I've had to deal with them more than once, and it takes 10 acts of congress to get them to do anything. Some you win, some you lose. But they don't have anyone there who can read an orthopedic op note from what I have seen.


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