April 21, 2022

Texas Medicaid: Prepare for upcoming review of infusion and injection claims

Effective Aug. 1, 2022, if an outpatient facility submits a claim for administering an infusion or injection to a UnitedHealthcare Community Plan member, we’ll deny the claim.

Why this change is occurring
Previously, a system error was allowing outpatient hospital care providers to be reimbursed for administering all infusions and injections.

The administration of an injection may only be paid to a physician who administers it. An injection or infusion administered by a nurse or other outpatient facility provider type is included in the emergency room charge and is not reimbursed separately.

What happens next
As a result of this error, we may have incorrectly paid some injection and infusion claims submitted using the UB04 form. As a result, we’ll be reviewing claims processed between Aug. 1, 2021, and July 31, 2022, to identify any that were paid incorrectly.

If we determine your claim was paid incorrectly, we’ll contact you to advise on next steps. This may include recouping funds that we paid in error.

Please contact your provider advocate or call Customer Service at 888-887-9003, 8 a.m.–6 p.m. CT, Monday–Friday.