UHC Defines Reasons for Rejecting Problematic Corrected, Duplicate and Multiple Claims

Avoid Claim Rejections: Important Guidelines for Submitting Corrected and Duplicate Claims

Effective April 1, 2025, UnitedHealthcare is reinforcing CMS and health plan claim submission rules. To prevent delays or denials, be sure to follow these updated guidelines:

• Submit one original claim per provider, per member, per date of service. Multiple original claims for the same date will result in rejections—only the first will be processed.

Corrected claims must:

• Include all services from the original submission—not just the revised line item.
• Be submitted with frequency code “7” and the original claim number.
• Be sent only after the original has been adjudicated.
• Duplicate claims with identical codes and service dates will be rejected. Check claim status before resubmitting, or request a reconsideration if you disagree with a decision.

Best Practices to Avoid Rejections:

• Consolidate services into a single claim per provider per date.
• Use correct modifiers or units to distinguish services.
• Wait for adjudication before submitting corrections.

You can submit corrected claims via:

• EDI – Use frequency code “7” and include the original claim number.
• Provider Portal – Sign in with your One Healthcare ID and follow the guided steps.
• Paper – Enter frequency code “7” in Box 22 and include the original claim number.

For full details and interactive guides, visit: UHCprovider.com

Tip: The Provider Portal offers the fastest way to submit corrected claims and get results quickly.

Source: https://www.uhcprovider.com/en/resource-library/news/2025/avoid-claim-rejections-denials.html?cid=em-providernews-2025nnb3-Feb25