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OPTUM CLAW BACKS FOR CODES 97139, 97039 WERE IN ERROR

ASA Insurance Chair, Mori West, has issued the following update:
Please disseminate this in ALL states that have Optum as the carrier for
the VA CCN – Regions 1,2,3 . The following states are NOT affected:
CA, MV, AZ, UT, OR, WA, ID, MT, WY, CO NM, TX, AK, HI.

Optum WAS sending out recoupment letters for codes 97139, 97039, going back to 2022. THIS WAS AN ERROR. They will recoup for these codes for any dates of service AFTER 2/23/2024, as those codes were removed from the list of authorized codes. Here is what we have received from Optum:

Good morning Mori –

This is the statement we will be relaying to providers: Optum’s Claims
Department worked a special project intended to remediate a historical
claims logic concern which impacted unlisted procedure codes. Although
our analysis of the unlisted procedure codes is ongoing, the current
recoupments are in the process of being voided. We sincerely apologize
for the inconvenience this has caused and appreciate your patience as we
work to void theses specific recoupments regarding the unlisted
procedure codes. Additional communication will be sent in advance of any
further actions related to the unlisted procedure codes after our
internal analysis is complete.

Sincerely,
____________________

Edgar L Neira
Network Provider Advocate, Network Management | OptumServe
VA CCN Region 1, 2, 3

NCSAAM will share more updates as they become available.

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