Optum incident
Resolved: Inhalation Medication/KX Modifier Requirement Changes
Resolved on April 30, 2026, affecting Pharmacy Network Solutions.
As previously communicated Optum Insight identified inconsistent payment activity and claim reopening outcomes across the DME MACs post-implementation of their new policy of requiring a KX modifier being submitted on inhalation drug claims. As a result, we placed all inhalation drug and corresponding dispensing fee claims on hold temporarily to prevent the occurrence of further denials. Optum Insight is pleased to share that we have completed system enhancements, including necessary coding updates resulting from collaborative testing. Consequently, all previously held claims have been released with the appropriate modifier codes as of Monday, April 27, 2026. We appreciate your continued partnership and remain available for any questions through our customer support team at 866-379-6389.
Affected components
Update timeline
- resolved Apr 30, 2026, 05:48 PM UTC
As previously communicated Optum Insight identified inconsistent payment activity and claim reopening outcomes across the DME MACs post-implementation of their new policy of requiring a KX modifier being submitted on inhalation drug claims. As a result, we placed all inhalation drug and corresponding dispensing fee claims on hold temporarily to prevent the occurrence of further denials. Optum Insight is pleased to share that we have completed system enhancements, including necessary coding updates resulting from collaborative testing. Consequently, all previously held claims have been released with the appropriate modifier codes as of Monday, April 27, 2026. We appreciate your continued partnership and remain available for any questions through our customer support team at 866-379-6389.
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