HCFA Physician Chemotherapy Claims Processing Errors and Recovery
- Amanda Bridges
- July 24, 2015
- News
UnitedHealthcare discovered a programming error in their claims system that has been incorrectly denying prior authorized chemotherapy treatments. This notice was placed on the company’s portal on July 23, 2015.
HCFA Physician Chemotherapy Claims Processing Errors and Recovery
UnitedHealthcare launched its Injectable Outpatient Chemotherapy Prior Authorization program requirement effective June 1, 2015 to improve the quality of oncology care for UnitedHealthcare members undergoing treatment.
A system issue was impacting injectable Chemotherapy HCFA claims causing the following claim types being incorrectly denied:
- Claims with valid authorization on file
- Claims for members on ASO (self-funded) employer policies who do not require a prior authorization for injectable chemotherapy
In both cases the reason listed for the denial or penalty will be lack of prior authorization.
We have identified the defect and a system fix was implemented on July 18, 2015. Claims submitted after July 18, 2015 should reimburse correctly.
Claims that were incorrectly denied are being reprocessed for payment. This work has already been started and all claims should be reprocessed by the end of August 2015. You do not need to resubmit these claims.
If you have any questions, please send an email to unitedoncology@uhc.com.
