We know you want to be paid promptly for your services. To help prompt payment:
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 Durable Medical Equipment (DME) (other than renal) (General Classification)
291 DME/Rental
292 Purchase of new DME
293 Purchase of used DME
300 Laboratory (General Classification)
301 Chemistry
302 Immunology
303 Renal Patient (Home)
304 Non-Routine Dialysis
305 Hematology
306 Bacteriology & Microbiology
307 Urology
309 Other Laboratory
310 Laboratory-Pathology (General Classification)
311 Cytology Histology
312 Other Laboratory Pathological
319 Radiology–Diagnostic (General Classification)
320 Angiocardiography
321 Arthrography
322 Arteriography
323 Chest X-Ray
324 Other Radiology-Diagnostic
329 Radiology-Therapeutic and/or Chemotherapy Administration (General Classification)
330 Chemotherapy Administration-Injected Chemotherapy Administration-Oral Radiation Therapy
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
359 CT-Other
360 Operating Room Services (General Classification)
361 Minor Surgery
362 Organ Transplant-Other Than Kidney Transplant
367 Other Operating Room Services
369 Other Imaging Services (General Classification)
400 Diagnostic
401 Mammography
402 Ultrasound
403 Screening Mammography
404 Positron Emission
409 Tomography 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)
471 Audiology/Diagnostic
472 Audiology/Treatment
480 Cardiology (General Classification)
481 Cardiac Cath Lab
482 Stress Test
483 Echocardiology
489 Other Cardiology
490 Ambulatory Surgical Care (General Classification)
499 Other Ambulatory Surgical Care
610 Magnetic Resonance Technology (General Classification)
611 MRI-Brain/Brain Stem
612 MRI-Spinal Cord/Spine
614 MRI-Other
615 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
732 Telemetry
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
922 Electromyogram
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)
Note: Use the Payer ID number on the member’s ID card. The electronic claims submission number does vary. The claim will reject if the correct Payer ID is not used.
If you believe your claim was processed wrong, call the number on the back of the member’s ID card. Request an adjustment as soon as possible, in accordance with applicable statutes and regulations. If you identify a claim overpayment, or we notify you of an overpayment, send us the overpayment within 30 calendar days from the date of identification or notification.
If you disagree with a claim payment determination or adjustment, you may appeal. Request a review by mail, fax or phone:
Grievance Administrator
P.O. Box 31371
Salt Lake City, UT 84131-0371
Standard Fax: 1-801-478-5463
Phone: 1-800-657-8205
If you feel your situation is urgent, request an expedited (urgent) appeal by mail, fax or phone:
Grievance Administrator
2020 Innovation Drive
DePere, WI 54115
Expedited Fax: 1-866-654-6323
Phone: 1-800-657-8205
Your appeal must be submitted within 12 months from the date of payment shown on the EOB, unless your Agreement with us or applicable law provide otherwise.
Refer to Claim reconsideration and appeals process section in Chapter 10: Our claims process.
If you disagree with the outcome of the claim appeal, you may file an arbitration proceeding as described in your Agreement.
Claim reconsideration does not apply to some states based on applicable state law (e.g., Arizona, California, Colorado, New Jersey, Texas). For states with applicable law, dispute requests will follow the state-specific process.
Disputes involving New Jersey commercial members are subject to the New Jersey state-regulated health care provider dispute process.
The state-regulated health care provider dispute process does not apply in the following situations:
UM denials include prescription quantity limit denials and requests for in-plan exception denials. You may appeal a UM denial by going through the Internal UM Appeals Process described under the Member Complaints and Grievances section. You must submit a completed Consent to Representation in Appeals of Utilization Management Determinations and Authorization for Release of Medical Records in UM Appeals and Independent Arbitration of Claims form to begin the UM appeal process.
The process does apply for the following situations:
If the dispute is eligible, the following process will apply:
Submit a written request for appeal using the Health Care Provider Application to Appeal a Claims Determination Form created by the New Jersey Department of Banking and Insurance. Submit the request within 90 days following receipt of our initial determination notice to:
UnitedHealthcare Oxford Navigate Individual
Grievance Administrator
P.O. Box 31371
Salt Lake City, UT 84131-0371
Standard Fax: 1-801-478-5463
We will review the request and tell you our decision in writing within 30 calendar days of receipt of the form.
If you are not satisfied with the decision, you may initiate the New Jersey Program for Independent Claims Payment Arbitration (PICPA) process. Submit your requests to Maximus, Inc. within 90 calendar days from receipt of the internal dispute decision. A dispute is eligible if the payment amount in dispute is $1,000 or more. The arbitration decision is binding.