Have you received a UHC Medicare Advantage claim denial indicating 'precertification/ authorization/ notification absent' for cases where clinical submission was not required? Did you follow the correct process? If so, we need redacted examples of cases indicating this disconnect so that Optum and UHC can address this issue.
As a reminder, and as noted in correspondence from Optum (summarized in the NYSCA News From The NIC, Lunch and Learn, and follow up communications), please follow the process outlined by Optum:
All Optum Physical Therapy, Occupational Therapy, Speech Therapy, and Chiropractic providers, including Tier 1A, Tier 1, and Tier 2 can verify that a PSF is required by going to www.myoptumhealthphysicalhealth.com >> Tools and Resources >> UHC Medicare Quick Group Check.
A tutorial and instructions on completing the online submission can also be found at:
Log on to www.myoptumhealthphysicalhealth.com
Select Tools and Resources >> Medicare User Guide
When utilizing the UHC Medicare Quick Group Check, verify that you did not accidently select the UHC Group Quick Check to ensure you obtain the correct submission requirement for each specific group.
As with any prior authorization scenario, the NIC recommends waiting at least 1 week from receipt of the approval before submitting your claim. This will allow time for the authorization information to become uploaded into the payor's claims processing system.
What do we need to help resolve this issue?
A copy of the Optum notice that "Clinical submission is not required for group xxxxx" and a redacted copy of the submitted claim for the same timeframe. Please email to [email protected] or fax to 518-785-6352, attn: NYSCA Insurance Committee.
HELP US HELP YOU
The NIC
