Beginning Nov. 7, 2020, initial claim denials will be communicated to you through a consolidated Explanation of Denial statement that outlines all claim denials processed each day. This consolidated statement will give line-by-line detail of the service(s) that have been denied in each claim and the reason for the denial. It replaces individual letters that currently are mailed for each separate claim denial, helping to reduce the volume of communication you receive from us. View a sample of the new consolidated Explanation of Denial.
Impacted States and Plans
- States: Arizona, California, Colorado, Nevada, Oklahoma, Oregon, Texas and Washington
- Plans: Only Medicare Advantage and Commercial plans covered by UnitedHealthcare West. (You may identify a UnitedHealthcare West member by a reference to “WEST” on the back of their ID card.)
This change applies only to claims that are denied in full. There is no change to how you’ll be notified when claims are approved or partially approved – you’ll continue to receive a Provider Remittance Advice (PRA) that outlines the charges submitted, benefits paid and member responsibility.
Questions? Please contact your Provider Advocate.