# UHC denying 90460 as a add-on code



## JodiLynn (Jul 7, 2021)

Peds here. We do lots of immunizations. In the past week UHC has started to reject claims with the vaccines/injection code 90460 and referencing smart edit P4999S45DN. I reviewed the edit and did not see anything about 90460. I Know they Its NOT an add-on code, but I've seen payers write wacky edits. I did see that an Add-on Code policy was updated on 6.28.21 (policy # 2021R0071A) stemming from an CMS update, but again nothing about that code in particular. On a somewhat good note, while they rejected in my clearinghouse they were actually accepted by the UHC and they paid the WCC, the imms, and even the 90461 (the true add on code) but denied the 90460. Was curious if anyone else is running into this issue?


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## hsumm817 (Jul 7, 2021)

Yes! I started getting this rejection as well, but for 90471. UHC rejects it stating its an add on code and must be used with the primary. I too could not find anything on the updates about the immunization admin. I went through and refiled my claims to try and by pass the smart edit. I think they may have a glitch in their system.


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## JodiLynn (Jul 7, 2021)

hsumm817 said:


> Yes! I started getting this rejection as well, but for 90471. UHC rejects it stating its an add on code and must be used with the primary. I too could not find anything on the updates about the immunization admin. I went through and refiled my claims to try and by pass the smart edit. I think they may have a glitch in their system.


Hopefully they will realize sooner than later. I already have 36 claims from 6/30 date of service till current with this issue


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## nneecole (Jul 9, 2021)

I am having the same problem. I found the following new policy. It doesn't make sense to me. The policy has a list of attached of add on codes and primary codes.


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## medcode12 (Jul 12, 2021)

Same problem. If someone gets resolution, please advise. Apparently they updated their add-on code policy 7/1/21. Still makes no sense to me. Also, 90471 & 90472 are being denied.


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## jolenm (Jul 14, 2021)

I just contacted our billing software about this last week and received an answer yesterday.  The clearinghouse reported these claims are rejecting due to UHC smart edit coding software stopping the claims just before they reach an actual processor.  Our rep advised even though the clearinghouse shows "rejected," if the claim was properly coded, UHC will automatically process and pay it anyway after 5 days. I should know if this is correct information by early next week.


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## lorimedbiller (Jul 16, 2021)

HI All!  Really makes no sense.  What if a patient comes in for a vaccine only.  There would be no primary code other than the actual vaccine itself.  Uhc needs to get its act together.  Has anyone heard anything more on this?


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## lorimedbiller (Jul 16, 2021)

jolenm said:


> I just contacted our billing software about this last week and received an answer yesterday.  The clearinghouse reported these claims are rejecting due to UHC smart edit coding software stopping the claims just before they reach an actual processor.  Our rep advised even though the clearinghouse shows "rejected," if the claim was properly coded, UHC will automatically process and pay it anyway after 5 days. I should know if this is correct information by early next week.


Mine went through after 5 days and then when I got the EOB, they were all denied as needing a primary code.  What a mess!


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## hsumm817 (Jul 23, 2021)

Mine also finally went through the clearing house, but now we are getting denials. On our ERA it states COB15 Service is included....but when you pull the claim up online it says 
REMARK CODES
OJ: THIS SERVICE REPRESENTS AN ADD ON CODE THAT IS ONLY CONSIDERED FOR REIMBURSEMENT WHEN REPORTED WITH A PRIMARY PROCEDURE THAT IS ALSO CONSIDERED FOR SEPARATE REIMBURSEMENT.

On hold now trying to get answers on the phone....


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## ploegeral (Jul 26, 2021)

I am having the same issue at a family practice- what a mess.


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## HarmanyB23 (Aug 16, 2021)

JodiLynn said:


> Peds here. We do lots of immunizations. In the past week UHC has started to reject claims with the vaccines/injection code 90460 and referencing smart edit P4999S45DN. I reviewed the edit and did not see anything about 90460. I Know they Its NOT an add-on code, but I've seen payers write wacky edits. I did see that an Add-on Code policy was updated on 6.28.21 (policy # 2021R0071A) stemming from an CMS update, but again nothing about that code in particular. On a somewhat good note, while they rejected in my clearinghouse they were actually accepted by the UHC and they paid the WCC, the imms, and even the 90461 (the true add on code) but denied the 90460. Was curious if anyone else is running into this issue?


Hi, Peds here as well. we are having the same issue. they are requesting we send in medical notes for each denial. I'm thinking another stall tactic from this large payor. its very frustrating on so many levels. if anyone has any advice with getting this issue fixed id love the input.


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## nneecole (Aug 16, 2021)

We waited 3 weeks and reprocessed all our claims. They all got paid. It must have been a software thing. Good luck everyone.


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## JenBailey (Aug 18, 2021)

I called and spoke with UHC on 8/1/2021-UHC became aware of this issue last month and per the rep I spoke with they are doing an internal audit to find and pay these denials. The following codes were affected 90460/90461/90471/90472/90474.  Hope that helps.


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## mmiele1979 (Sep 2, 2021)

nneecole said:


> We waited 3 weeks and reprocessed all our claims. They all got paid. It must have been a software thing. Good luck everyone.


When you say, reprocessed, you sent in corrections?  I have a few they still have not fixed.  Reps do not seem to be aware of this issue as they are parroting the denial and telling us it's valid.  I've even tried appealing and they get denied.  
I'm not sure what to do next.


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## midnight1995 (Sep 3, 2021)

Also having the same issue - just and FYI - I actually received and email from UHP EDI: 
United Healthcare had a SmartEdit in place on claims containing 90471 and 90460 stating (This service/procedure require qualifying service be received and covered). This are not add on codes, back on July 8, 2021 I had contacted EDI support regarding this SmartEdit – this is the information that was provided on 7/8/2021
- The SmartEdit team recently investigated the return edit that mentions add-on codes since it seemed to be triggering incorrectly. If nothing else, the codes are not considered add-on codes. What they found is that a programming issue for the system that bundles/unbundles service lines incorrectly identified these codes on June 27th. This is only for the Employer line of business and is a UnitedHealthcare, not a SmartEdit programming issue. . Please note that since this is a return edit the claims will be forwarded to UnitedHealthcare for processing after five business days. You will be sent a second notice acknowledging receipt of the claims. We may already have some of them. Unfortunately, since this is a claim platform system that also processes claims there may be some claims that deny these services during processing. Work is underway to fix this and any claims sent or processed after 7/11 will not reject for this problem. 
Please note if service lines are denied there are already plans to implement a project to adjust those claims and correct any payment denials. We suggest you not resubmit the claims as resubmitting will not fix the claims any sooner than the planned project. It would also delay that since the claim would have to be adjusted twice as opposed to once.
*** I had my billing contact claims department and they were unaware of a reprocessing of claims - the 2nd email I received back from EDI 8/13/2021: The EDI department cannot provide a timeline on when claims will be adjusted but we do know that the department adjusting claims is backlogged with the quantity of claims involved in this project and provider should reach out to their provider advocate.

Hope this helps.


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## mmiele1979 (Sep 3, 2021)

midnight1995 said:


> Also having the same issue - just and FYI - I actually received and email from UHP EDI:
> United Healthcare had a SmartEdit in place on claims containing 90471 and 90460 stating (This service/procedure require qualifying service be received and covered). This are not add on codes, back on July 8, 2021 I had contacted EDI support regarding this SmartEdit – this is the information that was provided on 7/8/2021
> - The SmartEdit team recently investigated the return edit that mentions add-on codes since it seemed to be triggering incorrectly. If nothing else, the codes are not considered add-on codes. What they found is that a programming issue for the system that bundles/unbundles service lines incorrectly identified these codes on June 27th. This is only for the Employer line of business and is a UnitedHealthcare, not a SmartEdit programming issue. . Please note that since this is a return edit the claims will be forwarded to UnitedHealthcare for processing after five business days. You will be sent a second notice acknowledging receipt of the claims. We may already have some of them. Unfortunately, since this is a claim platform system that also processes claims there may be some claims that deny these services during processing. Work is underway to fix this and any claims sent or processed after 7/11 will not reject for this problem.
> Please note if service lines are denied there are already plans to implement a project to adjust those claims and correct any payment denials. We suggest you not resubmit the claims as resubmitting will not fix the claims any sooner than the planned project. It would also delay that since the claim would have to be adjusted twice as opposed to once.
> ...


Thank you for this update (of course after I resubmitted yesterday) and it will most likely be a mess because we all know United likes to break these claims up CPT code by CPT code.  The least they could do is educate their provider reps instead of keeping them in the dark.  United really grinds my gears. (Family Guy reference, lol)  Again, thank you.


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## DGDONNA (Sep 8, 2021)

JodiLynn said:


> Peds here. We do lots of immunizations. In the past week UHC has started to reject claims with the vaccines/injection code 90460 and referencing smart edit P4999S45DN. I reviewed the edit and did not see anything about 90460. I Know they Its NOT an add-on code, but I've seen payers write wacky edits. I did see that an Add-on Code policy was updated on 6.28.21 (policy # 2021R0071A) stemming from an CMS update, but again nothing about that code in particular. On a somewhat good note, while they rejected in my clearinghouse they were actually accepted by the UHC and they paid the WCC, the imms, and even the 90461 (the true add on code) but denied the 90460. Was curious if anyone else is running into this il


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## DGDONNA (Sep 8, 2021)

I have received denials for 90460 and 90461 from Local 1199, they will no longer cover the code if its billed with a well visit. I am hoping others are not going to follow.


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## melissalynnfalkowski (Oct 21, 2021)

Please see attached guidance. You need to bill with the SL modifier on the immunization


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## mmiele1979 (Oct 21, 2021)

melissalynnfalkowski said:


> Please see attached guidance. You need to bill with the SL modifier on the immunization


speaking for myself, we already do this.  Denied anyway.


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