HCFA Physician Chemotherapy Claims Processing Errors and Recovery

Dear State Society Executive,

I’m writing to ask for your assistance with a recent issue at UnitedHealthcare.  We discovered a programming error in our claims system that has been incorrectly denying prior authorized chemotherapy treatments.  This notice was placed on the company’s portal today.

HCFA Physician Chemotherapy Claims Processing Errors and Recovery

UnitedHealthcare launched its Injectable Outpatient Chemotherapy Prior Authorization program requirement effective June 1, 2015 to improve the quality of oncology care for UnitedHealthcare members undergoing treatment.

A system issue was impacting injectable Chemotherapy HCFA claims causing the following claim types being incorrectly denied:

  • Claims with valid authorization on file
  • Claims for members on ASO (self-funded) employer policies who do  not require a prior authorization for injectable chemotherapy

In both cases the reason listed for the denial or penalty will be lack of prior authorization.

We have identified the defect and a system fix was implemented on July 18, 2015.  Claims submitted after July 18, 2015 should reimburse correctly.

Claims that were incorrectly denied are being reprocessed for payment.  This work has already been started and all claims should be reprocessed by the end of August 2015.  You do not need to resubmit these claims.

If you have any questions, please send an email to unitedoncology@uhc.com.

I have found that the state medical societies are one of the most effective ways to communicate with the medical oncology community. I would appreciate your assistance ensuring your members are aware of the issue and the correction that is underway.  Please also pass along my sincere apologies for the inconvenience this caused for your members.


Lee Newcomer, MD

SVP, UnitedHealthcare Oncology, Genetics and Women’s Health

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