Use electronic data interchange (EDI) to submit claims and conduct other business with us electronically. To enroll, call EDI customer service at 1-866-509-1593, or email RVITEDISolutions@uhc.com.
Tell your office software vendor that you want to begin transmitting electronic claims to the River Valley Payer ID 87726 for medical claims and 95378 for dental.
We receive all claims through our clearinghouse, OptumInsight. The clearinghouse sets up claims as commercial. Your EDI software vendor must establish connectivity to the clearinghouse. They can make sure you meet the requirements to transmit claims.
Your software vendor will give you a report showing an electronic claim left your office. It does not confirm we or the clearinghouse received or accepted the claim.
Clearinghouse acknowledgment reports show the status of your claims. They are given to you after each transmission. This lets you confirm whether a claim reached us, rejected because of an error or needed additional information.
We will also send you status reports providing more data on claims. These include copies of EOBs/remittance advice and denial letters that may request more information.
Carefully review all vendor reports, clearinghouse acknowledgment reports and the River Valley status reports when you receive them.
Submit all medical or hospital services claims using, as applicable, the CMS 1500 or UB-04 claim forms. Or use their successor forms for paper claims and HIPAA-standard professional or institutional claim formats for electronic claims. Use black ink when completing a CMS 1500 claim form. This helps us scan the claim into our processing system.
We require you to submit claims electronically, with few exceptions. For electronic claims submission requirements, refer to Requirements for complete claims and encounter data submission section in Chapter 10: Our Claims Process.
Share this document with your software vendor. We update the Companion Guide regularly, so review it to help ensure you have the most current information about our requirements.
For more information about electronic claims, refer to UHCprovider.com/claims.
The following claims require attachments. This means they must be submitted on paper:
Modifier 59 helps identify procedures/services commonly bundled together but may be appropriate to report separately. No special rules apply to electronic claims joined using Modifier 59 or for dental pre-treatment claims.
260 IV Therapy (General Classification)
261 Infusion Pump
262 IV Therapy/Pharmacy Services
263 IV Therapy/Drug/Supply Delivery
264 IV Therapy/Supplies
269 Other IV Therapy
290 DME (other than renal) (General Classification)
292 Purchase of New DME
293 Purchase of Used DME
300 Laboratory(General Classification)
303 Renal Patient (Home)
304 Non-Routine Dialysis
306 Bacteriology & Microbiology
309 Other Laboratory
310 Laboratory-Pathology (General Classification)
319 Other Laboratory Pathological
320 Radiology-Diagnostic (General Classification)
324 Chest X-Ray
329 Other Radiology-Diagnostic
330 Radiology-Therapeutic and/or Chemotherapy Administration (General Classification)
331 Chemotherapy Administration-Injected
332 Chemotherapy Administration-Oral
333 Radiation Therapy
335 Chemotherapy Administration-IV
339 Other Radiology-Therapeutic
340 Nuclear Medicine (General Classification)
341 Diagnostic Procedures
342 Therapeutic Procedures
350 CT Scan (General Classification)
351 CT-Head Scan
352 CT-Body Scan
360 Operating Room Services (General Classification)
361 Minor Surgery
362 Organ Transplant-Other Than Kidney
367 Kidney Transplant
369 Other Operating Room Services
400 Other Imaging Services (General Classification)
401 Diagnostic Mammography
403 Screening Mammography
404 Positron Emission Tomography
409 Other Imaging Services
410 Respiratory Services (General)
412 Inhalation Services
419 Other Respiratory Services
460 Pulmonary Function (General Classification)
469 Other-Pulmonary Function
470 Audiology (General Classification)
480 Cardiology (General Classification)
481 Cardiac Cath Lab
482 Stress Test
489 Other Cardiology
490 Ambulatory Surgical Care (General Classification)
499 Other Ambulatory Surgical Care
610 Magnetic Resonance Technology (MRT) (General Classification)
611 Magnetic Resonance Imaging (MRI)-Brain/Brain Stem
612 MRI-Spinal Cord/Spine
615 Magnetic Resonance Anglogram (MRA)-Head and Neck
616 MRA-Lower Extremities
618 MRA Other
618 Other MRT
623 Surgical Dressing
624 FDA Investigational Devices
634 Erythropoietin (EPO) < 10,000 units
635 Erythropoietin (EPO) > 10,000 units
636 Drugs Requiring Detail Coding
730 EKG/ECG (Electrocardiogram) (General Classification)
731 Holter Monitor
739 Other EKG/ECG
740 EEG (Electroencephalogram) (General Classification)
750 Gastro-Intestinal (GI) Services (General Classification)
790 Extra-Corporeal Shock Wave Therapy (formerly Lithotripsy) (General Classification)
921 Peripheral Vascular Lab
923 Pap Smear
924 Allergy Test
925 Pregnancy Test
929 Additional Diagnostic Services
940 Other Therapeutic Services (General Classification)
941 Recreational Therapy
942 Education/Training (Diabetic Education)
949 Other Therapeutic Services (HRSA-approved weight loss providers)
If you have a question about a pre-service appeal, see Pre-Service Appeals in Chapter 7: Medical Management.