Claim payment is subject to Reimbursement Policies for UnitedHealthcare Commercial Plans. Claims Estimator tools are not available for River Valley members.
Changes to these policies are announced in the Network Bulletin.
Coding edits may also effect reimbursements. We apply coding edits based primarily on the National Correct Coding Initiative (NCCI) edits developed by the Centers for Medicare and Medicaid Services (CMS) as well as the CMS’ Outpatient Code Editor (OCE). You may find NCCI and OCE edits on cms.gov > Medicare > Coding > National Correct Coding Initiative Edits.