UnitedHealthcare uses a customized version of the Ingenix Claims Editing System known as iCES Clearinghouse (v 2.5.1) and Claims Editing System (CES) to process claims in accordance with UnitedHealthcare reimbursement policies. UnitedHealthcare may modify this reimbursement policy from time to time by publishing a new version of the policy on this Website however, the information presented in this policy is believed to be accurate and current as of the date of publication. Finally, this policy may not be implemented in exactly the same way on the different electronic claim processing systems used by UnitedHealthcare due to programming or other constraints however, UnitedHealthcare strives to minimize these variations.
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Further, the policy does not cover all issues related to reimbursement for services rendered to UnitedHealthcare enrollees as legislative mandates, the physician or other provider contract documents, the enrollee’s benefit coverage documents, and the Physician Manual all may supplement or, in some cases, supercede this policy. Accordingly, UnitedHealthcare may use reasonable discretion interpreting and applying this policy to services being delivered in a particular case. This information is intended to serve only as a general reference resource regarding UnitedHealthcare’s reimbursement policy for the services described and is not intended to address every aspect of a reimbursement situation. Coding methodology, industry-standard reimbursement logic, regulatory requirements, benefits design and other factors are considered in developing reimbursement policy. This reimbursement policy applies to all professionals who deliver health care services. References to CPT or other sources are for definitional purposes only and do not imply any right to reimbursement. This and other UnitedHealthcare reimbursement policies may use CPT, CMS or other coding methodologies from time to time.
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This reimbursement policy is intended to ensure that you are reimbursed based on the code that correctly describes the procedure performed. You are responsible for submission of accurate claims requests. Reach out insurance for appeal status.IMPORTANT NOTE ABOUT THIS REIMBURSEMENT POLICY
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