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Fam Pract Manag. 2008;15(3):13

United Healthcare to pay same-day E/M claims retroactive to Aug. 27

United Healthcare announced a bit of good news last month for physicians: It will retroactively pay physicians 50 percent of their contracted rate for a problem-oriented evaluation and management (E/M) service performed the same day as a preventive service for the same patient, dating back to Aug. 27, 2007.

Previously, the insurer had pushed back that date to Dec. 8, citing a delay related to updating its claims processing system, which prevented the new policy from being implemented until Dec. 8. Then, after hearing complaints from physicians and professional organizations, including the AAFP, United Healthcare announced that it would pay affected claims back to Oct. 15. And now, the company is honoring its original date of Aug. 27.

United Healthcare is identifying and adjusting claims dated from Aug. 27 through Dec. 8, so physicians do not need to seek adjustments for those claims.

Californians can complain online about insurers

If you live in California and have a complaint about a health insurance company, Los Angeles City Attorney Rocky Delgadillo wants to hear from you.

Delgadillo's office is investigating the business practices of health plans and health insurers that do business in the state. As part of that investigation, it launched a Web site – – in February to gather information from both patients and providers.

Delgadillo's task force wants to hear from patients who feel that their health insurer wrongfully denied or delayed their claim or canceled their coverage. Providers are encouraged to report instances in which they feel an insurer has improperly withheld payment, delayed payment or retroactively denied payment.

Insurers have faced increasing criticism in California lately. In January, the state's Department of Insurance announced it would seek $1.3 billion in penalties from PacifiCare based on 133,000 alleged violations of state laws regarding payments that occurred after UnitedHealth Group took over the company two years ago.

One key NPI deadline passes, another approaches

If you're one of the 10 percent of physicians still filing claims without a National Provider Identifier (NPI) number, the Centers for Medicare & Medicaid Services (CMS) has been trying to get your attention. March 1 marked an important deadline that will affect whether your claims are paid:

  • As of March 1, Medicare carriers are rejecting claims submitted without an NPI number for the primary provider.

  • Also as of March 1, Medicare carriers are rejecting claims with only a Medicare legacy number in the primary provider field.

If you missed that deadline, you still have time to hit the next key one. After May 23, all electronic Medicare claims must be billed using only your NPI number. CMS is encouraging all Medicare providers to test their electronic claims now to make sure that any issues are resolved before May 23 arrives.

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