Medical Billing Terms U-V: Utilization Review, UB-04 and Void Claims

Utilization review is a payer check on whether care is medically necessary. This page defines it with the terms from UB-04 to Vyne Dental, including underpayment, unlisted procedure code, UCR, value-based care and void claim. MCM South Medical Billing Service, LLC works only in mental and behavioral health billing.

Last reviewed: October 10, 2026Sources linked at each term

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Billing Terms Glossary slide, Terms U-V: Utilization Review - MCM South Medical Billing Service, LLC

Glossary pages

0-9 A B C D E F G H I J K-L M N-O P Q-R S TU-VW-Z

On this page (19 terms)

UB-04 (CMS-1450)
Underpayment
Unified Program Integrity Contractor (UPIC)
UnitedHealthcare
Units
Unlisted Procedure Code
URAC
USCDI
Usual, Customary and Reasonable (UCR)
Utilization Rate
Utilization Review (UR)
Valant
Value-Based Care
Veradigm
Veterans Affairs Community Care
Virtual Credit Card (VCC)
Visit Limit
Void Claim
Vyne Dental

How to use these Utilization Review definitions

Use this page as a quick reference for Utilization Review, from UB-04 (CMS-1450) to Vyne Dental. Each entry gives a plain definition, why it matters to a mental health practice, and an official source. When a rule changes by payer or state, the entry says so, so confirm Utilization Review details with the payer before you bill.

Checklist: put the utilization review definitions to work

UB-04 (CMS-1450): Facility-based behavioral health programs bill on it, while private practices usually do not.
Underpayment: Left unchecked, systematic underpayments become large lost revenue.
Unified Program Integrity Contractor (UPIC): A UPIC contact is a serious event that calls for counsel.
UnitedHealthcare: Has its own portals, policies, and behavioral health arrangements.

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UB-04 (CMS-1450)

General (all payers)

Also called UB-04; CMS-1450; institutional claim form

Definition: The standard claim form for institutional providers such as hospitals and facilities, maintained by the NUBC, whose electronic equivalent is the 837I.
Why it matters: Facility-based behavioral health programs bill on it, while private practices usually do not.
Illustrative example: A partial hospitalization program bills on the UB-04.

Reference sourceNUBCchecked 10/9/26

CategoriesClaims Processing EDI & Clearinghouse Terms

Underpayment

General (all payers)

Also called underpaid claim; short pay

Definition: A payment less than the contracted or expected amount for a covered service.
Why it matters: Left unchecked, systematic underpayments become large lost revenue.
Illustrative example: A payer pays $105 on a $130 contracted rate.

Reference sourceCMS (Centers for Medicare & Medicaid Services)checked 10/9/26

CategoriesPayment & Reimbursement Denials & Appeals

Unified Program Integrity Contractor (UPIC)

General (all payers)

Also called UPIC; program integrity contractor

Definition: A CMS contractor that investigates potential fraud, waste, and abuse in Medicare and Medicaid.
Why it matters: A UPIC contact is a serious event that calls for counsel.
Illustrative example: A provider receives a records request from a UPIC.

Reference sourceCMS (Centers for Medicare & Medicaid Services)checked 10/9/26

CategoriesAudits & Compliance Medicare & Medicaid Terms

UnitedHealthcare

Private payer

Also called UHC; United Healthcare

Definition: A national health insurer that is part of UnitedHealth Group and offers commercial, Medicare Advantage, and Medicaid plans.
Why it matters: Has its own portals, policies, and behavioral health arrangements.
Illustrative example: A provider checks UnitedHealthcare's provider portal for authorization rules.

Related termsOptum

Reference sourceUnitedHealthcarechecked 10/9/26

CategoriesBCBS, UHC & Commercial Payer Terms

Units

General (all payers)

Also called billing units; service units

Definition: The quantity of a service billed, such as 1 for a session or multiple for time-based HCPCS codes.
Why it matters: Wrong units cause underpayment or denial.
Illustrative example: A 15-minute HCPCS code for a 45-minute service is billed as 3 units where the payer allows.

Reference sourceCMS (Centers for Medicare & Medicaid Services)checked 10/9/26

CategoriesClaims Processing

Unlisted Procedure Code

General (all payers)

Also called unlisted code; 90899; unlisted psychiatric service; not otherwise classified

Definition: An unlisted procedure code is a CPT code used when no specific code describes the service provided. Psychiatry has its own unlisted code, and every unlisted claim needs a description of the service.
Why it matters: Payers usually require a written description and often pay by their own review. Use it only when no code fits.
Illustrative example: A provider bills an unlisted psychiatric service with a description and supporting documents.

Reference sourceAmerican Medical Association (AMA)checked 10/9/26

CategoriesClaims Processing

URAC

General (all payers)

Also called URAC accreditation

Definition: An independent accrediting organization for health plans, utilization review, and other health care organizations.
Why it matters: Some payers and utilization-review vendors hold URAC accreditation, shaping their review standards.
Illustrative example: A utilization review vendor states it is URAC-accredited.

Reference sourceURACchecked 10/9/26

CategoriesCredentialing & Enrollment Quality & Risk Adjustment Terms

USCDI

General (all payers)

Also called United States Core Data for Interoperability

Definition: A standardized set of health data classes and elements for nationwide exchange.
Why it matters: Defines minimum data EHRs must be able to share.
Illustrative example: An EHR exports USCDI data elements.

Related termsInteroperability FHIR

Reference sourceHHS (U.S. Department of Health and Human Services)checked 10/9/26

CategoriesEHR & Healthcare Technology Terms

Usual, Customary and Reasonable (UCR)

General (all payers)

Also called UCR; usual and customary; U&C

Definition: A method some payers use to set the maximum allowable amount for out-of-network services, based on what providers in an area typically charge.
Why it matters: OON reimbursement is often calculated from UCR, not from the provider's billed charge.
Illustrative example: A plan pays 70% of its UCR amount, which is lower than the practice's billed fee.

Reference sourceCMS (Centers for Medicare & Medicaid Services)checked 10/9/26

CategoriesPayment & Reimbursement Contracting & Network Management

Utilization Rate

General (all payers)

Also called clinician utilization; schedule fill rate

Definition: The share of available appointment slots that are filled with billable sessions.
Why it matters: Ties capacity to revenue.
Illustrative example: A therapist fills 25 of 30 weekly slots.

Related termsNo-Show Rate Productivity Metrics

Reference sourceMGMAchecked 10/9/26

CategoriesRevenue Cycle Metrics

Utilization Review (UR)

General (all payers)

Also called UR; utilization management; UM

Definition: A payer process that evaluates whether requested or delivered care is medically necessary and appropriate.
Why it matters: UR drives authorizations, concurrent review, and many behavioral health denials.
Illustrative example: A payer's UR nurse reviews a request for additional sessions.

Reference sourceURACchecked 10/9/26

CategoriesPrior Authorization Terminology Audits & Compliance

Valant

General (all payers)

Also called Valant Behavioral Health EHR

Definition: A vendor of EHR and practice management software designed for behavioral health practices. Listed for reference; not an endorsement or partnership.
Why it matters: Behavioral-health-specific workflows and measurement tools.
Illustrative example: A psychiatry group documents in Valant.

Reference sourceValantchecked 10/9/26

CategoriesEHR & Healthcare Technology Terms

Value-Based Care

General (all payers)

Also called VBC; value-based payment; pay for value

Definition: Payment models that reward quality and cost outcomes rather than volume of services.
Why it matters: Changes documentation, reporting, and revenue for practices in such contracts.
Illustrative example: A payer offers a bonus for meeting measurement-based care goals.

Reference sourceCMS (Centers for Medicare & Medicaid Services)checked 10/9/26

CategoriesValue-Based Care Terminology

Veradigm

General (all payers)

Also called Allscripts legacy

Definition: A health technology company, formerly Allscripts, offering EHR and related software. Listed for reference; not an endorsement or partnership.
Why it matters: Legacy Allscripts name appears in older documents.
Illustrative example: A practice uses Veradigm for e-prescribing.

Reference sourceVeradigmchecked 10/9/26

CategoriesEHR & Healthcare Technology Terms

Veterans Affairs Community Care

Private payer

Also called VA Community Care Network; CCN; VA community care

Definition: A program through which the Department of Veterans Affairs authorizes care from community providers for eligible veterans.
Why it matters: Requires VA authorization and has its own billing rules and networks.
Illustrative example: A community therapist provides care under a VA authorization.

Related termsTRICARE Prior Authorization

Reference sourceU.S. Department of Veterans Affairschecked 10/9/26

CategoriesMedicare & Medicaid Terms

Virtual Credit Card (VCC)

General (all payers)

Also called VCC; virtual card payment

Definition: A one-time credit card number a payer or vendor sends to pay a claim, often with processing fees to the provider.
Why it matters: Card fees reduce net payment, so practices often prefer EFT.
Illustrative example: A payer pays by virtual card; the practice pays a merchant fee to process it.

Reference sourceCMS (Centers for Medicare & Medicaid Services)checked 10/9/26

CategoriesPayment & Reimbursement

Visit Limit

General (all payers)

Also called session limit; annual visit limit; benefit limit

Definition: A plan cap on the number of visits or sessions it will cover in a period.
Why it matters: Exceeding a limit leads to denials and may raise a parity question if similar limits do not apply to medical benefits.
Illustrative example: A plan covers 20 outpatient therapy visits per calendar year.

Reference sourceCMS (Centers for Medicare & Medicaid Services)checked 10/9/26

CategoriesEligibility & Benefits

Void Claim

General (all payers)

Also called frequency code 8 claim; cancel claim

Definition: A claim sent to cancel a previously paid or accepted claim.
Why it matters: Used to remove an incorrect claim before rebilling.
Illustrative example: A claim billed under the wrong provider is voided and rebilled.

Reference sourceX12 NUBCchecked 10/9/26

CategoriesClaims Processing

Vyne Dental

General (all payers)

Also called Vyne; Vyne Dental clearinghouse

Definition: A clearinghouse and technology company focused on dental claims and attachments. Listed for reference; not an endorsement or partnership.
Why it matters: Primarily dental, so rarely used in behavioral health billing.
Illustrative example: A dental practice submits claims through Vyne.

Reference sourceVyne Dentalchecked 10/9/26

CategoriesEDI & Clearinghouse Terms

Quick answer: Utilization Review

What is utilization review?

Utilization Review (UR) is a payer process that evaluates whether requested or delivered care is medically necessary and appropriate. UR drives authorizations, concurrent review, and many behavioral health denials.

Frequently asked questions: Utilization Review

What is an unlisted procedure code?

An unlisted procedure code is a CPT code used when no specific code describes the service provided. Psychiatry has its own unlisted code, and every unlisted claim needs a description of the service. Payers usually require a written description and often pay by their own review.

What is a void claim?

A void claim is a claim sent to cancel a previously paid or accepted claim. Used to remove an incorrect claim before rebilling.

What is a UB-04?

UB-04 (CMS-1450) is the standard claim form for institutional providers such as hospitals and facilities, maintained by the NUBC, whose electronic equivalent is the 837I. Facility-based behavioral health programs bill on it, while private practices usually do not.

Related resources

Where MCM South works

MCM South serves psychotherapists and psychiatrists in ten states: Georgia, Massachusetts, Connecticut, Texas, Florida, New York, Colorado, Tennessee, North Carolina and Illinois.

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