As of July 1, 2022, Medicare Advantage and commercial claims for sepsis-related treatment may be reviewed on a pre-payment or post-payment basis. These reviews promote accurate diagnosis and treatment of sepsis and help ensure the claim is coded and billed at the appropriate treatment level.
Claims will be reviewed using UnitedHealthcare’s Sepsis Clinical Guidelines and the patient’s medical records to validate that sepsis was present. Subject to state laws and regulations, and as indicated in the guidelines, UnitedHealthcare uses Sepsis-3, the most recent evidence-based definition of sepsis and supports The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3) | Critical Care Medicine | JAMA | JAMA Network and the Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021 | SpringerLink.
Here’s what you need to know
Please contact your Provider Advocate or call UnitedHealthcare Provider Services toll-free at 877-842-3210, 7 a.m.–5 p.m. CT, Monday–Friday.