Readmission claims review letter process change

We’re changing how we communicate Medicare and Medicaid readmission claim determinations to align with the way other pre-pay claim decisions are communicated.

Effective Dec. 31, 2026, separate provider letters for certain readmission claim determinations will be discontinued. This includes determinations involving preventable readmissions, planned leaves of absence, same-day readmissions or readmissions related to a prior admission. Starting Jan. 1, 2027, providers should review the provider remittance advice for the claim adjudication outcomes and applicable adjustment denial information.

This change doesn’t apply to inpatient level-of -care determinations. Letters associated with those determinations will continue to be sent.

This update won’t affect Medicare readmission policies or review criteria, claims adjudication methodology, contractual requirements, information available regarding claim determinations through standard claim reporting resources or existing reconsideration, dispute or appeal rights. Members will continue to receive claim adjudication outcomes through the explanation of benefits and other standard claim reporting tools.

Plans excluded from this change

• UnitedHealthcare Community Plan of Washington