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 2. Claims, billing and payments

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CLAIMS, BILLING AND PAYMENTS

Health care provider claim submission tools and resources. Learn how to submit a
claim, submit reconsiderations, manage payments, and search remittances.

Health care professionals working with UnitedHealthcare can use our digital
tools to access claims, billing and payment information, forms and get live
help. To begin using the UnitedHealthcare Provider Portal sign
inopen_in_new with your One Healthcare ID. 


ARE YOU A MEMBER LOOKING FOR A PROVIDER?

Find in-network providers at myuhc.comopen_in_new.





DIGITAL TOOLS 

Our digital solutions are designed to give you the most up-to-date claims status
and payment information quickly and easily. Our digital solutions comparison
guideopen_in_new can help identify which tools are right for you.


UNITEDHEALTHCARE PROVIDER PORTAL

You can manually process 20 transactions at a time in the portal. The portal is
ideal for transactions that aren’t compatible with automated Electronic Data
Interchange (EDI) and organizations with low transaction volume or minimal IT
support.

Document Library houses claim, prior authorization and payment (including
overpayment and appeal) information so authorized users can access it right
away. 

Sign in UnitedHealthcare Provider Portal open_in_new


APPLICATION PROGRAMMING INTERFACE

Application Programming Interface (API) is designed to help your organization
improve efficiency, reduce costs and increase cash flow. Using automatic data
feeds, API distributes information in a timely and effective manner. API is
commonly used by practices, facilities, health care systems, vendors,
clearinghouses and revenue cycle management companies.

Exploreopen_in_new API to determine if it’s the right solution for you.


ELECTRONIC DATA INTERCHANGE

Electronic Data Interchange (EDI) allows for multiple patient and payer digital
submissions, and receiving batch transactions and is commonly used by health
care professionals, facilities and sometimes clearinghouses.

The EDI overviewopen_in_new can help you decide if it’s the right solution for
you.


DIGITAL PAYMENT OPTIONS 

You have 2 options for receiving payments from UnitedHealthcare. Read more about
our digital payment options to help decide which option is right for you.

Both options are facilitated by Optum Pay®,open_in_new a full-service payment
and remittance solution used by all sizes and types of health care
organizations. Learn how to enroll.open_in_new

Automated Clearing House (ACH)/direct deposit
Learn more about this option, also known as electronic funds transfer (EFT), in
our enrollment guide.open_in_new It outlines why it’s preferred by most
practices because of its speed and efficiency in depositing payments directly
into a bank account. Each payment is issued for the full amount of the claim
payment at no charge to you.

Virtual card payments (VCP)
A virtual card is issued for each payment and transactions are processed as
credits through the same terminal used for patient copays. Our user
guideopen_in_new walks you through the enrollment process.




Expand All add_circle_outline
Guides and training
expand_more

Claims and billing interactive guide open_in_new 
View claim status, take action (if needed), check the status of tickets and
more.

Claims reconsideration quick start guide open_in_new
Get details on how you can submit claim reconsideration requests with one
easy-to-use tool. It uses the most up-to-date claims status and payment
information, and there’s no need for mailing or faxing.

Claims status quick start guide open_in_new
Learn how to check your claims status and payment information without mailing or
faxing.

TrackIt interactive guideopen_in_new
See how TrackIt can serve as your daily to-do list. You can view your recent
workflow at a glance, see what needs attention and take action. 

Review the full list of claim related education

Documents and forms
expand_more

Claims overpayment refund/notification form – single or multipleopen_in_new
Please submit this form with your refund, so we can properly apply the check and
record the receipt. If a check is included with this correspondence, please make
it payable to UnitedHealthcare and submit it with any supporting documentation.

Claim reconsideration form – single claimopen_in_new
Skip the reconsideration form and submit your claim reconsideration
electronically through the UnitedHealthcare Provider Portalopen_in_new. Once
submitted, you'll receive a ticket number to check the status of your
reconsideration request later.

Misdirected claim returns to the health plan coversheets
If the Health Plan forwarded claims to you that you believe are the Health
Plan’s responsibility according to the Division of Financial Responsibility
(DOFR), please return with the appropriate cover sheet.

Reports and other resources
expand_more

Capitation, Claim, Quality, Roster and Profile Reports
You can access a variety of capitation, claim, quality and profile reports along
with provider rosters with the UnitedHealthcare Reports application.

The Consumer Assessment of Healthcare Providers and Systems (CAHPS®) and the
Health Outcomes Survey (HOS) provides feedback on patient experiences. Our goal
is to continue to help improve the overall experience for your patients and our
members. 

CMS-1500 Fee Source Links  open_in_new
View the Centers for Medicare & Medicaid Services (CMS) 1500 fee schedule and
sources. 

Outpatient Procedure Grouper (OPG) Exhibits 
Use the OPG Exhibits to determine reimbursement for outpatient procedures. The
exhibits list valid CPT®/HCPCS codes and indicate which codes are eligible for
reimbursement.

Revenue cycle management companies
The Digital Solutions for Revenue Cycle Management Companies interactive
guideopen_in_new provides a quick overview for those who provide services on
behalf of health care professionals.  

West Plan Codes Report
Find more information about the UnitedHealthcare West Plan Codes Report and NICE
system. The plan codes support billing, claim payments and more.

No Surprises Act resources
expand_more

Batched items or services guidance  open_in_new
Guidance for reviewing provider remittance advice (PRAs) to determine which No
Surprises Act claims can be batched for the Independent Dispute Resolution (IDR)
process.




NEED HELP?

Connect with us through chat 24/7 in the UnitedHealthcare Provider
Portal.open_in_new




NEWS

See all news arrow_forward

October 10, 2024


DEC. 1: ELECTRONIC APPEAL AND DISPUTE SUBMISSIONS REQUIRED FOR ARIZONA MEDICAID



Health care professionals must submit Medicaid pre- and post-service appeals and
disputes electronically in Arizona.

Read Full Update Dec. 1: Electronic appeal and dispute submissions required for
Arizona Medicaid

September 30, 2024


DEC. 1: ELECTRONIC RECONSIDERATION AND APPEAL SUBMISSIONS REQUIRED



Health care professionals must submit Medicaid medical reconsiderations and
appeals electronically in Louisiana and Pennsylvania.

Read Full Update Dec. 1: Electronic reconsideration and appeal submissions
required

September 30, 2024


MINNESOTA MEDICAID: YOUR CLAIMS MAY BE DENIED IF YOU’RE NOT ENROLLED BEFORE OCT.
1



See how to avoid claim denials if you’re contracted with a Medicaid MCO or have
recently billed as an MCO network provider.

Read Full Update Minnesota Medicaid: Your claims may be denied if you’re not
enrolled before Oct. 1

September 30, 2024


JAN. 1: ELECTRONIC RECONSIDERATION SUBMISSIONS REQUIRED



Health care professionals must submit Medicaid claim reconsideration submissions
electronically in Arizona.

Read Full Update Jan. 1: Electronic reconsideration submissions required

September 30, 2024


REGISTER CERTAIN TESTS FOR PHASE 3 OF THE DEX Z-CODES



Starting Oct. 1, you can register tests that are in scope for phase 3 of the DEX
Z-Codes®.

Read Full Update Register certain tests for phase 3 of the DEX Z-Codes

September 19, 2024


NEW JERSEY MEDICAID: CONSENT FORM REQUIRED WITH ANY STERILIZATION CLAIM



Per state guidelines, UnitedHealthcare Community Plan of New Jersey requires a
consent form with any sterilization claim.

Read Full Update New Jersey Medicaid: Consent form required with any
sterilization claim




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