Wiki UHC and X-rays

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alk@APS

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Is anyone else having issues with UHC and x-rays? We are getting denials from them when we charge an x-ray with an office visit or x-rays during post-op period. We are being told x-rays are inclusive?
Thanks
 
Yes I am having that problem as well. They are denying our x-ray stating it is bundled into the office visit or vice versa! I have contacted our provider rep and sent her examples and its been over a week but they are looking into the issue.
 
POS 32 Denials

Was this ever resolved in a satisfactory manner? We are also receiving UHC denials on the basis of xrays being inclusive since the SNF is also billing with POS 32, as are we. We've tried explaining that we are a separate entity and that our services are not inclusive with the facility's. Anyone having the same issue or have any ideas on how to make them understand?
 
Here is what happen with my escalated issue with UHC. Hope this helps!
Summary:

· Provider is questioning: Is there a known issue regarding the x-ray or the office visit stating that “97-payment is included in the allowance for another service/procedure?”

· Provider states some claims are reprocessed for reconsideration & some are not. Ultimately, they are being denied at first pass & should not be.

· Please have claims reprocessed to pay add'l. Please advise provider if there is a known system issue, as these are only a few examples.



Resolution:

· E&M codes were bundled into code 73560 incorrectly per the Global Days Policy. The Global Days Policy has since been updated and that code has been removed.

· All three claims were reentered and reprocessed per the update to the Global Days Policy. Please see attached spreadsheet for claim and payment details.
 
Commercial as well

Along with the UHC community and shared plans we are also having problems with the commercial plans...does anyone else see that also....also does anyone have any suggestions on how to move forward? I would really appreciate the input...
 
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