September 02, 2015
Area(s) of Interest: Commercial Payors Payor Issues and Reimbursement
UnitedHealthcare (UHC) has identified an error in the processing of physician claims related to its Injectable Outpatient Chemotherapy Prior Authorization program requirement, which became effective June 1, 2015. Between June 1 and July 18, 2015, incorrect denials of “lack of prior authorization” may have been generated for injectable chemotherapy claims submitted with valid authorizations on file or submitted for patients with self-insured employer policies where preauthorization of injectable chemotherapy is not required. UHC has advised that a system fix was implemented on July 18, 2015, and all claims after this date should process correctly.
Claims that were denied incorrectly were automatically reprocessed for payment by UHC; all affected claims should have been reprocessed by the end of August 2015. If you have any questions, please contact UHC via email at firstname.lastname@example.org.