Exceeding Maximum Dosage Billing Issues

Last modified: June 16, 2020

If you’re experiencing billing issues for drugs with established maximum dosages, please review the United Healthcare Commercial Medical & Drug Policy Coverage Determination Guidelines when submitting your claim. This may help you reduce rejections and allow for quicker payment processing.

We review claims to help ensure the billed dosage of these medications is consistent with the UnitedHealthcare Commercial Medical Benefit Drug Policy - Maximum Dosage. Any claims that are billed exceeding maximum dose not consistent with supported drug policy may be denied. In these cases, a representative from Optum will contact your practice to review the claim.

We encourage you to check these guidelines periodically for updates.