Reimbursement policies, River Valley - 2022 UnitedHealthcare Administrative Guide

Claim payment is subject to reimbursement policies on > Commercial Policies > Reimbursement Policies for Commercial. Claims Estimator tools are not available for River Valley members.

We will inform you of changes to these policies on > Network Bulletin.

Coding edits may also affect 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 > Medicare > Coding > National Correct Coding Initiative Edits.