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For information on the Change Healthcare cyber responseopen_in_new




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
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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 companiesopen_in_new
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

July 17, 2024


NPI NUMBER AND TAXONOMY CODES REQUIRED AUG. 1, 2024



New York Medicaid health care professionals will need to submit an NPI number
and taxonomy code with claims.

Read Full Update NPI number and taxonomy codes required Aug. 1, 2024

July 17, 2024


OKLAHOMA: STAY IN OUR NETWORK, FILE ALL CLAIMS



Oklahoma requires us to remove health care professional with no recent claims on
file from our network.

Read Full Update Oklahoma: Stay in our network, file all claims

July 09, 2024


REQUIRED BILLING FOR TENNESSEE MEDICAID NETWORK HEALTH CARE PROFESSIONALS



Submit claims for allied health care professionals with their NPI and Medicaid
ID.

Read Full Update Required billing for Tennessee Medicaid network health care
professionals

July 08, 2024


NEW JERSEY: DENIED CLAIMS WILL NO LONGER BE AUTOMATICALLY REPROCESSED



We will stop automatically reprocessing denied claims if you are registered for
the 21st Century Cures Act program.

Read Full Update New Jersey: Denied claims will no longer be automatically
reprocessed

June 28, 2024


MASSACHUSETTS MEDICAID: USE APPROPRIATE BILLING CODES FOR FASTER DME CLAIMS
PROCESSING



Correct billing code information for power wheelchair repairs for
UnitedHealthcare Community Plan of Massachusetts plan members.

Read Full Update Massachusetts Medicaid: Use appropriate billing codes for
faster DME claims processing

June 19, 2024


OHIO MEDICAID: BALANCE BILLING IS NOT PERMITTED



See what steps you can take to stay compliant with balance billing regulations.

Read Full Update Ohio Medicaid: Balance billing is not permitted




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