UnitedHealth, Texas medical group battle over claims processing technology

A contract dispute between Austin (Texas) Regional Clinic and UnitedHealthcare will leave about 5,000 patients with UnitedHealthcare AARP Medicare Advantage plans searching for new physicians or new insurance plans next year.

Here are five things to know:

1. UnitedHealthcare notified patients enrolled in its Medicare Advantage plan that Austin Regional Clinic, a multispecialty medical group with 24 locations, will be out of their network next year, according to the Austin-American Statesman. The change will not affect patients with UnitedHealthcare commercial plans or any Medicare supplement plans.

2. UnitedHealthcare and the medical group terminated contract negotiations after they were unable to agree on which claims processing technology to use.

3. Austin Regional Clinic wanted to use its own technology to process claims because it needs quicker access to claim reports, and its physicians don't want to use multiple platforms. Three other Medicare Advantage plans agreed to use the clinic's technology, Norman Chenven, MD, founding CEO of Austin Regional Clinic, told the Austin-American Statesman.

4. UnitedHealthcare said Austin Regional Clinic's physicians have always had access to patient claims. "The reason ARC decided to leave UnitedHealthcare's network is not because they couldn't access patient claims," a UnitedHealthcare spokesperson told the Austin-American Statesman. "ARC has always had access to claims data for services that they render to their patients. ARC wanted to leverage a third-party organization's technology for processing patients' claims. UnitedHealthcare already has this capability locally in Austin, which UnitedHealthcare offered ARC."

5. Although patients with UnitedHealthcare Medicare Advantage plans can continue to receive in-network care at Austin Regional Clinic through Dec. 31, clinic officials said the insurer recently told patients they had been assigned a new physician with a different provider group as of Oct. 1. UnitedHealthcare disputes the clinic's claims. The insurer said Austin Regional Clinic was not terminated from its network early, according to the report.

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