Optume Pre-Payment Denials Tips
Has anyone had success with appeals regarding Optume Pre-payment denials? We've noticed an increasing amount, especially with Aetna on these. They almost never reference their policies and cite CMS mostly. I've sent and referenced our OR, supply, and room/board policies in appeals as well as their own online policies where they state supplies are covered. They tend to send a generic response that seemingly ignores our appeals. Just curious what others experiences have been with these?
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The answer is in your contracting team's hands. They signed the contract that allows the payer to do this immoral stuff so they own the consequences and the remedy.
We are having the same issue; however, we do get a few to overturn partially. BCBS never considers our appeals for prepayment denials.