UHC placing ‘pre-pay’ review on some Covid claims

March 22, 2021

Multiple labs Vachette works with have recently received pre-payment records requests from UnitedHealthcare to support their Covid-19 testing. While UHC isn’t denying these tests for improper coding, the payments they’ve put on hold amount to nearly $1 million in some instances.

Despite our attempts to provide documentation, the payer has continued to hold these charges by claiming they haven’t received the paperwork or need additional records. When reaching out to Optum directly, our client was only informed that the review was, “based on the billing pattern submitted to insurance, including lab orders and the number or frequency performed for a patient.” 

As we try to gauge how widespread this issue is, please reach out to us directly if you’ve been impacted by similar practices. While it’s not surprising to see UHC use this tactic, it still feels like it’s going against the intent of the CARES Act and recent Biden Executive Order to broadly cover Covid testing for individual clinical assessment for the duration of the Public Health Emergency.

Who's reviewing revenue strategy with you at this time?

Are you billing all the correct CPT codes? You’d be surprised at what you might be missing. We will review your Fee Schedule/Charge Master at no cost.

That’s right. For free.

Share This