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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President at Association for Healthcare Denial and Appeal Management | dwilson@intersecthealthcare.com | Website | + posts

Denise serves as the Senior Vice President at Denial Research Group – AppealMasters. Denise is also President of The Association for Healthcare Denial and Appeal Management. Denise is a Registered Respiratory Therapist, Registered Nurse, and holds a Master’s degree in Management Information Systems from the University of Illinois, Springfield.

Denise has over thirty years of experience in healthcare, including clinical management, education, compliance, and appeal writing. Denise has extensive experience as a Medical Appeals Expert and has personally managed hundreds of Medicare, Managed Medicare, and Commercial appeal cases and presented hundreds of cases at the Administrative Law Judge level.

Denise is a nationally known speaker and dynamic educator on Medicare and Commercial appeals processes, payer behaviors, standards of care, appeal template development, and building a road map to drive the payer to a decision in the provider’s favor. She has educated thousands of healthcare professionals around the country in successfully overturning medical care denials.