Wiki OON provider- United Healthcare remark code 29

[jdobbins10]

I work for an OON provider and over the past 6 months, we have seen a huge decline in our revenue with UHC. Most of our claims show a remark code of 29 on the EOB. Which states that UHC is using some type of competitive database to price our claims. The payments that we are getting are way below Fair Health and Medicare rates. When we call UHC to question, the reps are clueless. They keep telling us that each claim was priced based of U&C or R&C. Please Help! We have filed Underpayment Recons & Appeals with no luck. They all denying saying that our claims were processed correctly.

Thank you,
J. Dobbins CPB

 

[SharonCollachi]

It doesn't matter what UHC prices the claims as, since you are out of network, you are entitled to 100% of your billed charges from all sources. Whatever the insurance doesn't pay is patient responsibility. Bill the patient. If the patient has a problem, they need to call UHC at the member services number on their card.

 

[sls314]

I'm not sure I'd even waste my time submitting for an underpayment review. You're OON - there isn't a contractual rate that you're being underpaid against. As Sharon said, you can bill the patient for the balance up to your billed charges.

If this is becoming an administrative hassle, you could stop accepting UHC patients. Or join the network, if you don't want to turn away patients.