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.

For More Information:

https://www.uhcprovider.com/en/resource-library/news/2021-network-bulletin-featured-articles/0521-sepsis-claims.html

https://www.uhcprovider.com/content/dam/provider/docs/public/policies/clinical-guidelines/sepsis.pdf


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