OPA-MCE Login | Print Page | Contact Us | Sign In | Join OPA
Director of Professional Affairs Blog
Blog Home All Blogs
Search all posts for:   


View all (20) posts »

Claim Rejections from United Health Care Community Plan

Posted By Jim Broyles, PhD, OPA Director of Professional Affairs, Thursday, August 30, 2018

Recently I've read posts on the listserv or received individual emails regarding claim rejections from United Health Care Community Plan, which is a Medicaid Managed Care plan.  The rejections are for basic services including psychotherapy.  There has been ongoing speculation about whether this may be a new plan which does not include behavioral health services.  EOB's received by providers even include a rejection reason which states psychotherapy is not a covered service.   To clarify, this plan is required to cover these basic services.  When managed care companies contract with the State of Ohio to manage a Medicaid program, they are required according to their agreement to offer all services offered directly by Medicaid.

In recent weeks, I have been in ongoing communication with UHCCP regarding these claim rejections which they acknowledge were done in error.  According to the information I received during a conference call this morning, the rejections were the result of a systems error associated with large systems changes they were required to make, and as of today they believe the problem has been solved.   Their hope is that all claims for initial evaluation and psychotherapy will be processed appropriately from this date forward (test claims have been successful), and that wrongly rejected claims will be reprocessed and reimbursed soon.   Panel members will be receiving a notice directly from UHCCP soon regarding this issue.

I urge OPA members to email me if your experiences with UHCCP are not consistent with this.  I also urge anyone to reach out regarding any claim rejection from any company that seems questionable. 



This post has not been tagged.

Share |
Permalink | Comments (0)