I was curious to see if anyone was having issues with United Healthcare with upholding preventative services for medical record request. We bill for Pediatric and Family Medicine we have seen an increase with claims being pended for additional information and to please submit to Optum for review.

My current workflow is to submit the medical records via UHC Link and follow up with Optum directly with the Ticket number to confirm records received and under review. Most cases Optum has received them and will be approved for payment.

However the past month I have had nothing but issues with the Optum in regards to the vaccines/vaccine administration codes/escalated cases/communication back to the claims department.

Optum requires 5 pieces of information in regards to the vaccine details: Vaccine Name, Dosage, Administration Site, Route of Administration and the employee’s name/credentials that provided the vaccine. All of this information is included in our documentation however Optum has still denied stating documentation is insufficient.

Escalated cases sent back for review but often no action is taken.

Optum reviewed medical records and approved line items for payment. However when communication is submitted to UHC claims department only partial claim is paid out or payment is never issued. Therefore I’m having to go back an forth between Optum and the Claims Department and in some case had to have a 3-way call with these departments. Very frustrating to say the least!

For now I have submitted an claim list to our UHC provider rep to get some assistance in regards to our outstanding claims. Is anyone else having issues? If so, please comment as this is an ongoing issue for our practice.

Thank you in advance for any feedback you may have.