UnitedHealthcare – Billing Notice for IV and SC Immune Globulin and Remicade

February 2018 ~

UnitedHealthcare (UHC) has issued a notice to inform care providers about a billing issue for Intravenous (IV) and Subcutaneous (SC) Immune Globulin (IG) and Remicade^® (IV) affecting outpatient facilities.

UHC states it has received claims related to its commercial plans and its Community Plan without the appropriate ICD-10-CM diagnosis billing codes as listed in UHC Medical Benefit Drug policy guidelines.

The insurer states claims will be reviewed to help ensure the condition treated with these medications is consistent with the Medical Benefit Drug policy. Any claims that have a diagnosis not consistent with the drug policy may be denied. In these cases, a representative from Optum will contact the care provider to review the claim.

UHC adds that providers and billing professionals should note that using the correct ICD-10-CM code doesn’t guarantee coverage of a service. The service must be used consistent with the criteria outlined in the UHC Medical Benefit drug policies.

Source(s): UnitedHealthcare Network Bulletin;