As of October 1st, 2024, Optum and United Healthcare updated their requirements for supervised appointments under commercial health plans in California, Colorado, Iowa, and Massachusetts. These appointments now require the supervisor’s name and NPI in box 17 of claims, and the U5 modifier in box 24d.
To review the documentation for these new requirements, see Outpatient Services Rendered Under Supervision - Commercial and the Reimbursement for Supervisory Services Reference Guide. For questions about the requirements, we recommend contacting Optum or United Healthcare directly.
Note: These payers have additional requirements for the supervising information included in box 24j of claims. For guidance on these, see Billing insurance under your supervisor's credentials.
In this guide, we’ll cover:
Including the supervisor’s name and NPI in box 17
Supervised appointments with Optum and United Healthcare under commercial health plans in specific states require the supervisor’s full name and referring provider type in box 17 and their NPI in box 17b. To automatically populate this information for a client’s claims:
- Navigate to the client's Overview page
- Click Edit
- Choose the Billing and Insurance tab
- Under Insurance Claim/CMS Fields, check the box next to Show additional claim fields
- Select DQ - Supervising Provider Claim Level from the Referring provider dropdown menu
-
Enter the supervisor’s name and NPI
- The Outside Lab?, Lab Charges, and Client account number fields aren’t required
- Click Save Client
Once this is saved, claims created for the client moving forward will automatically include the supervisor’s information in boxes 17 and 17b.
To include the supervisor’s information in previously created claims that haven’t been submitted, we recommend deleting and recreating them, or editing them manually. For guidance on resubmitting rejected or denied claims, see Resolving claim rejections and Submitting a corrected claim.
Adding the U5 modifier to appointments and claims
Supervised appointments with Optum and United Healthcare under commercial health plans in specific states require the U5 modifier for each service in box 24d. To automatically add the U5 modifier to new appointments:
- Navigate to the client's Overview page
- Click Edit
- Select the Billing and Insurance tab
- Scroll down to Client Default Services and select a default Service Code from the dropdown
- Enter U5 in the Modifiers field
- Click Save Client
After this is saved, new appointments created for the client will automatically populate this service code and the U5 modifier. Claims created for these appointments will also populate this information.
To add the modifier to appointments you’ve already created, see Adding modifiers to individual appointments. If you’d like to add the modifier to claims you’ve already created but haven’t submitted, you can edit the claims manually, or delete and recreate them after adding the modifier to each appointment.
Note: For guidance on resubmitting rejected or denied claims with updated details, see Resolving claim rejections and Submitting a corrected claim.