United Healthcare Denied 11,900 California Claims in Error
[Posted 01/18/087]

CMA has learned that United Healthcare erroneously denied nearly 12,000 claims from California physicians between October 29 and November 30. A system glitch caused some claims to be fed through the adjudication platform twice, causing the claims to be denied.

United Healthcare has fixed the problem and affected claims will automatically be reprocessed by the insurer this month. Physicians do not need to appeal or resubmit these claims for reconsideration.

Claims that may have been denied inappropriately as a result of this system issue can be identified by the following remark codes on the Explanation of Benefits (EOB)s.

• Remark Code O9: The number of units reported exceeds the typical frequency per day.
• Remark Code O7: Our records show we have already processed this charge.
• Remark Code O6: Our records show these services have been previously submitted by another physician or other health care professional.
• Remark Code Q9: This procedure code and modifier are the same as or equivalent to another procedure code and modifier shown on this same claim submission or a prior claim submission.