Reduce claim returns and rework
Fewer returned claims mean faster payments and better efficiency. This resource explains the most common reasons claims aren’t approved and how to fix them. By learning the top return codes and following a few simple tips, you can submit cleaner claims and reduce rework.
Top reasons claims are returned
The following section highlights the most common return codes across all health care provider types, along with guidance to help you avoid them.
| Denial code | Reason | How to avoid |
|---|---|---|
0053 |
Duplicate denial |
Submit 1 complete claim per provider and date; Use modifiers; wait for adjudication before corrections. |
14 |
Incorrect coding |
Review reimbursement policies; Use correct codes and frequency code “7”. |
263 |
Claim timeliness |
Submit claims within required timeframes based on your contract. |
0026 |
Prior authorization required |
Obtain authorization before providing services. |
Claim return reasons by health care provider type
Each section lists the top claim return codes specific to each health care provider type. Codes already covered in the above section are excluded unless more context is needed.
| Denial code | Reason | Additional notes |
|---|---|---|
14 |
Incorrect coding |
Common codes: 99213, 99214, G2211. Review your policy for preventive services. |
| Denial code | Reason | Additional notes |
|---|---|---|
14 |
Incorrect coding |
Common codes: 99213, 99214. Review your policy for family health services. |
| Denial code | Reason | Additional notes |
|---|---|---|
0053 |
Duplicate denial |
Applies frequently to recurring therapy sessions. Use the correct modifier. |
No additional denial reasons beyond those listed in the "Top reasons claims are returned section"
Claims correction details
Your agreement with UnitedHealthcare requires you to submit all claim information, including corrected claims, within the required number of days after the date of service, discharge or final outpatient visit. Refer to your internal contracting contact or Participation Agreement for timely filing information.
Example
If the last date of service is May 1 and your agreement allows 90 days for timely filing, UnitedHealthcare must receive all claim information—including corrections—by July 30.
You must submit corrected claims either electronically or by paper. Use frequency code “7” in all cases.
Electronic submission
- Sign in to the UnitedHealthcare Provider Portal
- Click Claims & Payments
- Select Act on a Claim
- Choose Submit corrected claim
- Use frequency code “7”:
- In the 2300 Loop CLM05-03 field, or
- As the last digit of the institutional bill type
Paper submission
- Use frequency code “7” in Box 22 (left-justified)
- Include the original claim number in the “Original Reference Number” field
A claim with a different bill type than the original is not a corrected claim.