Claims and Payments | UnitedHealthcare Community Plan of New Jersey

Claim reminder for Medicaid nutritionist services

Verify the maximum units allowed for CPT codes
If your nutritionist services claim exceeds the maximum number of units allowed, your claim will be denied. Per your agreement, UnitedHealthcare Community Plan of New Jersey reimburses a specific number of units per member, depending on the service provided. We will not reimburse any services provided beyond the accepted amount.

What you can do
Before submitting the claim, verify the total number of units for the CPT® code. To see the maximum number of units allowed for reimbursement, go to the New Jersey entry in the state exceptions table.

Note: As is standard with all procedures, you’re not permitted to balance bill members for unpaid claim amounts.

CPT® is a registered trademark of the American Medical Association.

If you aren’t satisfied with the outcome of a claim reconsideration request, you may submit a formal claim dispute/appeal using the process outlined in your Care Provider Manual.

• A formal claim dispute/appeal is a comprehensive review of the disputed claim(s), and may involve a review of additional administrative or medical records by a clinician or other personnel.
• UnitedHealthcare Community Plan generally completes the review within 30 calendar days. However, depending on the nature of the review, a decision may take up to 60 days from the receipt of the claim dispute documentation. We’ll contact you if we believe it will take longer than 30 days to render a decision.
• Additional state requirements may apply. Please consult your state’s Care Provider Manual for more details.

Please allow 10 business days from the submission date before requesting a status update to enable us to begin processing the review.

To view current claim reconsideration information, go to UHCprovider.com/claims.

Direct deposit and VCP information is available to EPS-enrolled care providers in the Electronic Payments & Statements (EPS) tool.

Using Electronic Data Interchange (EDI) for all eligible UnitedHealthcare transactions can help your organization improve efficiency, reduce costs and increase cash flow. We encourage you to use the following tools and resources to get started with electronic transactions.

A PRA is generated for every processed claim and includes relevant details about how the claim was processed.