UHC to Audit Sepsis Claims on a Pre-Pay Basis

By Denise Wilson | May 11, 2021 | Audits, Denials, Evidence-Based Guidelines, Medicare Advantage, Sepsis

United Healthcare (UHC) has announced that effective July 1, 2021, Medicare Advantage and commercial claims for sepsis-related treatment may be reviewed on a pre-payment or post payment basis. Currently, UHC only review sepsis-related claims on a post-payment basis. Claims will be reviewed using UnitedHealthcare’s Sepsis Clinical Guidelines which endorse the Sepsis-3 definition.

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