Wiki Any Advice?

[StacyGalloway]

UHC Community Care is auditing charts from 2020-2023. They have determined through their audit that some of the charges that we submitted do not support the level of CPT that was billed. I am under the understanding that we cannot even go back and submit corrected claims to only have a portion of the $ returned due to the fact that it is past any timely filing requirement. #1 Is it common practice for an audit company, ADVIZE, to request payment back to them? Usually we have seen payment sent back in the form of recoupment. #2 How far back and insurance companies go when auditing? Any help/advice would be appreciated.

 

[TatyanaNegovan]

It is payors' discretion's process. But you still have an option to dispute legit services.
"I am under the understanding that we cannot even go back and submit corrected claims to only have a portion of the $ returned due to the fact that it is past any timely filing requirement. #1 Is it common practice for an audit company"
Here is how:
1) Correct claim and resubmit; communicate your process with provider representative;
2) Claim will be denied for TF;
3) Contact IC's provider representative to waive TF denial for corrected claim and provide all necessary supportive documentation and your mitigation steps timely taken.

Kindest regards,