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This document outlines the procedures for adjusting claims that are overpaid.
What is the Overpayment Adjustments SOP.
The document provides information regarding the different types of remark codes and when and how they are used during the claim payment process.
What is the Remark Codes SOP.
This document helps determine pend codes.
What is the ACORPND Auto Closure Pend File.
This document is for Non-PAR claims processed under the OCM Program.
What is the Outlier Cost Management Rework SOP.
This document provides the guidelines for prevention of inappropriate Medical Review referrals.
What is the MCR Referral Policy SOP.
This document is to provide guidelines/protocol on identifying claims in-scope for special processing in accordance with State/Federal Mandates and UHC guidelines in response to the Novel Coronavirus 2019 crisis.
What is the Transaction Novel Coronavirus COVID 19 State of Emergency SOP.
This document assists with Pay with Precision, similar to EDC Analyzer, except that the decision to down-code a service comes from Optum.
What is the Guidelines for Handling Optum Issues
Job Aid.
This document provides instructions and general information for remark code 3C denials.
What is the Medical Audit and Review Solution MARS Editing Process SOP.
This document provides the CPT procedure codes and HCPCS codes that Medicare does not cover.
What is the Medicare Not Covered Procedure Codes - Reconsidered Claims and Medicare Invalid Code Listing SOP.
This document provides instructions for processing UB04 OPS claims submitted with a bilateral surgical procedure.
What is the UB Modifier 50 SOP.
This document discusses ICES denied claims associated with the professional/technical component policy. The service was performed in a facility setting and is not eligible for separate reimbursement to the provider.
What is the IA Adjustment and Appeal Policy SOP.
The purpose of this document is to communicate how to handle recall claims received in queue and reconsideration requests of claims denied with recall remark codes.
What is the Recall Claims Processing SOP.
This document provides information on how to access the EDS screens and how to manipulate these screens for not covered dollars.
What is the EDS 56 and 5565 UNET Screens SOP.
The purpose of this document is to outline the procedures to be followed when using the Split Service Line and/or Split Claim utilities.
What is the CAMS Split Service Line and Split Claim SOP.
This job aid provides the process for handling claims that generate E-584 and/or are stuck in UFE.
What is the E584 Policy Runout Job Aid.
This document assists with processing claims paid by a Government assistance policy when member had primary group coverage through UnitedHealthcare.
What is the Medicaid Reclamation SOP.
This document provides the process for dedicated processors to handle global maternity claims for groups which have adopted the women's health benefit.
What is the HCR Women's Health Care Preventive Process SOP.
This document is to communicate the transition of NDC pricing for providers with an IPA of 000994 for the pre-pricing of home infusion and specialty medicine claims.
What is the ppoONE NDC Pre Pricing Solution SOP.
This document will assist with using the EDC Analyzer to apply correct coding to PPR (Percentage Payment Rate provider contract type).
What is the Emergency Room (ER) Care SOP.
This document provides direction on how to address provider inquiries that may be related to claims stuck in UFE/Echo due to OON providers billing UHC for the first time.
What is the Enhanced Provider Validation (EPV) Process SOP.
This document is to provide processing instructions when handling claims that denied with a AY or GG denial.
What is the Hospital Reference Laboratory Protocol Denial SOP.
This document assists with reviewing claims that are submitted using 1500 Claim form for two or more medical or surgical procedures, performed on the same date of service by the same individual physician.
What is the Multiple Procedure Processing SOP.
This document provides the steps for manually backing out claims in history.
What is the Manual Adjustment Procedures SOP.
This document provides processing guidelines for W3045 when manual intervention is required for professional claim only.
What is the Telehealth Parity SOP.
The SOP provides instruction for interpretation of a UNET provider SPI for injectable drugs, to determine if a SPI requires J code pricing.
What is the Calculating an Average Wholesale Price (AWP) Allowance SOP.