Avoiding Returned Claims

Reduce the time it takes to process your claim and avoid a returned claim by completely and correctly filling in the claim form. The following items, if missing or incorrect, will delay processing of your claim or even result in a request for re-submission:

• Subscriber's name
• Subscriber's member ID number (11-digits)
• Patient's name and date of birth
• Date of service
• UHA group number (4-digits)
• Name of referring physician for claims from laboratories, radiologists, and consultants
• Date, place, and cause of injury
• Descriptive diagnosis and ICD-9 code
• Descriptive procedures and CPT code
• Charges
• Provider's billing name and address
• Provider or agent's signature
• Supportive data for modifiers, e.g., after-hours modifier - claim should have time listed
• Provider Identification Number (PIN)
• Federal tax ID number

Requesting Reconsideration of a Claim

If you believe a claim should not have been denied, or disagree with the amount of the payment, you may request that we review the claim¹. We will review your request and get back to you within two business days. We will then provide you with an estimate of the time it will take to resolve your issue. We may request additional written information from you (e.g., additional diagnostic information, emergency notes or an operative report) to aid in the review process.

If you need to request reconsideration of a claim, please contact Member Services. Have the following information readily available before calling:

• Member name
• Member ID (11-digit number)
• Provider Identification Number (PIN)/National Provider Identifier (NPI)
• Date of service
• Amount billed

Upon review completion, one of two things may happen:

1. We will reprocess the claim (and send you a new Remittance Advice Summary), or
2. We will inform you why we believe our original determination was correct. If the matter is not resolved to your satisfaction, you may appeal our decision to our Appeals Committee.

For more information on how to file an appeal or for general claims information, please refer to our Provider Handbook.