OptumRx: UnitedHealthcare of Louisiana Care Provider Fee

claims processed from Feb 2, 2015 through May 31, 2016

Author: Kailee Burnett/Monday, July 31, 2017/Categories: APCI Choice, CAPS

UnitedHealthcare Community Plan of Louisiana completed an internal audit and found that some pharmacy claims processed from Feb 2, 2015, through May 31, 2016, didn’t include the $0.10 care provider fee that was due to you for each claim.  
 
During the next six weeks, we’ll be reprocessing the affected claims. You don’t need to take any action. You will see on the provider remittance advice that the affected claim was reversed and reprocessed. You’ll be paid $0.10 for each claim that we reprocess because it was missing the care provider fee. 
 
For instance, if the initial claim was missing the fee and was processed to pay you $5, the reprocessed claim will show that we’re reimbursing you $5.10. The new reimbursement will show as credited and your original reimbursement will show as debited, leaving you with a balance in this example of $0.10.
 
 
We’ll be monitoring claims to make sure these fees are included in the future. Thank you.

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