Quote:
Originally Posted by Aces4
According to my sources, (having been through a recent miscoding and claim denial), only the provider or their coders have the ability to submit, change or correct a claim. I was advised the supplemental insurance company (UHC) has no hand in the codes provided and cannot change them. The changes must come through the provider and this issue occurred a little over a year ago.
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So, UHC falling back on process, correct, however, UHC has to provide the coding for the provider to be paid in the first place. If UHC is asked by the provider the reimbursement rates by coding, they will still fall back upon on the process for plausible deniability, even though they provided information, maybe with encouragement (need voice recordings for that, though there are defenses for that to insure that they don't get caught).
So per the UHC contract for reimbursement rates, who does provide the codes for the provider to use? certainly UHC or is there a universal standard for procedure codes for everyone to use for each procedure?