UnitedHealthcare “Always Therapy” Code Reimbursement Error for Community Plan Claims

June 2019 ~

On May 21, UnitedHealthcare (UHC) discovered a claim edit was incorrectly loaded into its system.

As a result, UnitedHealthcare Community Plan claims that included “Always Therapy” codes with and without the GN, GO or GP modifiers were denied for claims submitted on or after May 19, 2019.

According to the insurer, UHC is taking the following steps to correct this issue:

• The UHC claims system was updated on May 22, 2019, to remove the edits that were loaded incorrectly.
• UHC is working to identify affected claims and reprocess them as quickly as possible.
• Once claims are reprocessed, affected care providers will receive payment for the correct reimbursement amount.

What This Means for Providers:

• While UHC works to identify and reprocess affected claims, implementation of the edit requiring the modifier on “Always Therapy” codes will be postponed until September 1, 2019.
• For dates of service on or after September 1, the GN, GO or GP modifiers will be required on “Always Therapy” codes.
• Denials will only occur if the “Always Therapy” codes are reported without one of the required modifiers.
• Claims are still subject to other reimbursement policy edits, coverage and/or benefit determinations.

Source(s): United Healthcare;