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GLP, Ganoderma lucidum polysaccharides

If the reported J1 services on a claim map to different C-APCs, we designate the J1 service assigned to the C-APC with the highest comprehensive geometric mean cost as the primary service for that claim

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UnitedHealthcare has a two-level appeal process: Level 1 appeal (internal): Submit within 180 days of denial Include provider letter explaining medical necessity Include supporting clinical documentation (labs, medication trial records, weight logs) Decision within 30 days for standard appeals, 72 hours for urgent appeals Approval rate on Level 1 appeals: 22% Level 2 appeal (external review): Available if Level 1 denied Reviewed by independent third party, not UnitedHealthcare Must file within 60 days of Level 1 denial Decision is binding on UnitedHealthcare Approval rate on Level 2 appeals: 38% The appeal success rate is higher for diabetes indication (45% combined Level 1 + Level 2) than weight-loss indication (28% combined)