UnitedHealthcare
UnitedHealthcare Insurance Company / United HealthCare Services, Inc. · UnitedHealth Group · NAIC 79413
Where to send the appeal
Verified addresses and inbound channels. We refresh on every release.
Response timeline
The clocks that matter. Miss them and you escalate to the state insurance commissioner.
Codes worth fighting
Based on outcome data across our payer corpus.
- CO-97
- CO-18
- CO-4
- CO-167
- CO-204
- CO-50
- CO-29
- PR-1
Modifier behavior
The denials this payer applies on modifier-bearing claims. The rebuttal language is part of the Denial OS letter generator and not published here.
Modifier 25
Significant, Separately Identifiable E/M ServiceUHC's claim editing engine flags modifier 25 on same-day E/M + procedure with above-baseline aggressiveness; documentation must clearly establish a SEPARATE chief complaint distinct from the procedure indication.
Modifier 59
Distinct Procedural ServiceUHC frequently denies modifier 59 on PT/OT same-day bundling under CO-97; recommend X{EPSU} subset modifiers (XE, XP, XS, XU) where applicable per CMS NCCI guidance.
Modifier GP
Outpatient PT plan of careRequired for outpatient PT services. Missing GP triggers automatic denial.
Interest statute
The legal basis for charging interest when payment runs late.
Varies by state — CA Insurance Code §10123.13 / TX Insurance Code §1301.103 / NY Insurance Law §3224-a / FL Statute §627.6131 / WA WAC 284-43-321
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