There is growing proof that medical providers are not up to date on why and when they should submit the mandatory Optum/United Healthcare Patient Summary Form. Here at Account Matters we are hearing first hand from clinics who are being denied payment because they are failing to submit this mandatory paperwork with UHC when required.
Here is what you need to know:
The Patient Summary Form was created for certain UHC plans to provide the insurance company with an explanation for the patient’s visit and confirm the need for treatment. The Patient Summary Form must be submitted via fax or on-line and the timely filing deadline for providing this documentation is 10 days from the date of service.
Failure to timely submit the Patient Summary Form will result in loss of payment. If the claim is denied, an appeal may be filed but payment will only be received from UHC if you provide an “acceptable” explanation; leaving the chances of payment solely up to UHC’s discretion.
There are two options you can use to determine if the patient has a plan with benefits that require a Patient Summary Form. You can either call Optum Health Care Solutions at 1-888-329-5182 or log onto www.myoptumhealthphysicalhealth.com and use the “quick group check” utility located in the "Tools and Resources" section.
It doesn’t take long to check and submitting the form in a timely manner will ensure payment and eliminate the hassle of having to file an appeal. We hope this helps you “Get Paid Right the First Time”.
If you have a billing problem you need solved, let us know at 508-422-0233. We can help!