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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.


CLAIMS, BILLING AND PAYMENTS


CLAIMS, BILLING AND PAYMENTS


CLAIMS, BILLING AND PAYMENTS


UNITEDHEALTHCARE PROVIDER PORTAL TOOLS

Submit and track your claims, manage payments and get the details on Electronic
Data Interchange for batch processing.

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CLAIMS

View and submit claims and view, submit and flag reconsiderations; submit
information on pended claims, and find confirmations and access letters,
remittances advices and reimbursement policies.


OPTUM PAY

Enroll in Optum Pay, select payment method and view payments, search payment
remittance and download and print remittance advices.

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ADDITIONAL PAYER TOOLS

Learn about more tools and resources to support your practice's work with claims
and payments.

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EDI

The Electronic Data Interchange (EDI) gives you an efficient electronic method
for submitting and receiving batch transactions for multiple patients and
payers.

Learn more



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ADMINISTRATIVE GUIDES


FREQUENTLY SEARCHED

Claims and billing training open_in_new
Interactive Guide: Use the UnitedHealthcare Provider Portal to view claim
status, take action, if needed, check the status of tickets and more.

Claims Status Quick Start Guide open_in_new
Get the most up-to-date claims status and payment information - all in 1
easy-to-use tool without mailing or faxing.

Claims Reconsideration Quick Start Guideopen_in_new
Get the most up-to-date claims status and payment information, and the ability
to submit your claim reconsideration requests — all in one easy-to-use tool
without mailing or faxing.

Claims Options: TrackIt Quick Start Guideopen_in_new
TrackIt serves as your daily to-do list. Need to upload a document? Are we
missing some information to process your claim? TrackIt will tell you. No need
to pick up the phone or wait for the mail. You can complete many actions without
leaving the tool.

Claim Reconsideration Form - Single Claimopen_in_new
This form is to be completed by physicians, hospitals or other health care
professionals for paper Claim Reconsideration Requests for our members.

Claims Overpayment Refund Form - Single or Multipleopen_in_new
Please complete this form and include it with your refund so that 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.

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 the claims with the appropriate cover sheet.

Point of Care Assist®
Point of Care Assist® (POCA) adds real-time patient information —including
clinical, pharmacy, labs, prior authorization, eligibility and cost transparency
— to your existing electronic medical records (EMRs) to make it easier for you
to understand what patients need at the point of care.

Electronic Payment Solutions
Quicker access to payments for healthcare professionals. Choose between
ACH/direct deposit or virtual card payments. Learn more or find helpful
resources today.

Courtesy Review Authorization Form - Claim Appeal - UnitedHealthcare Commercial
Plansopen_in_new
Member authorization form for a designated representative to appeal a
determination. For use with claim appeal process when unable to access online
tools. 

UnitedHealthcare West Capitation, Settlement, Shared Risk Claims, Eligibility,
and Patient Management Reports
Access a variety of capitation, claim, quality and profile reports along with
provider rosters with the UnitedHealthcare West Reports app.

Hospital Performance-Based Compensation Program
This program provides an incentive to hospitals for quality and efficiency
improvements in the delivery of health care affecting the overall health of
UnitedHealthcare Commercial members and cost of health care.

Digital solutions for Revenue Cycle Management companies and business vendors
Information to help revenue cycle management companies also referred to
occasionally as billing companies, work with UnitedHealthcare. 

UnitedHealthcare Capitation, Claim, Quality, Roster and Profile Reports
Access a variety of capitation, claim, quality and profile reports along with
provider rosters with the UnitedHealthcare Reports app.

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

CAHPS and the Health Outcomes Survey
The Consumer Assessment of Healthcare Providers and Systems (CAHPS®) survey and
the Health Outcomes Survey (HOS) help provide feedback on your patient’s
experience with you, the provider and us. UnitedHealthcare’s goal is to continue
to help improve the overall experience for your patients and our members. 

View 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.

Waiver of Liability Form for UnitedHealthcare Medicare Advantageopen_in_new
A non-contract provider, on his or her own behalf, may request a reconsideration
for a denied claim only if the non-contract provider completes a Waiver of
Liability (WOL) statement, which provides that the non-contract provider will
not bill the enrollee regardless of the outcome of the appeal.

CMS 1500 Fee Sources open_in_new
View the Centers for Medicaid and Medicare Services 1500 fee schedule and
sources 

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