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Claims and payments

We have online tools and resources to help you manage your practice’s claim submissions and payments.

 

Need to submit a claim, check status or submit a reconsideration request? Use the Claims and Payments tool found within theUnitedHealthcare Provider Portal. For more information, visit our Claims, billing and payments page.

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If you aren’t satisfied with the outcome of a claim reconsideration request, you may submit a formal claim dispute/appeal using the UnitedHealthcare Provider Portal.  You can find more information or other submission options outlined in your Care Provider Manual.

 

  • A formal claim dispute/appeal is a comprehensive review of the disputed claim(s), which may involve a review of additional administrative or medical records by a clinician or other personnel.
  • UnitedHealthcare Community Plan generally completes the review within 30 calendar days. However, depending on the nature of the review, a decision may take up to 60 days from the receipt of the claim dispute documentation. We’ll contact you if we believe it will take longer than 30 days to render a decision.
  •  Additional state requirements may apply; please consult your state’s Care Provider Manual for more details.

 

Please allow 10 business days from the submission date before requesting a status update to enable us to begin processing the review.

To view current claim reconsideration information, sign in to the UnitedHealthcare Provider Portal. You can learn more by viewing our interactive guide.

There are 2 options available for care providers who are enrolled to receive electronic payments from UnitedHealthcare — Automated Clearing House (ACH)/direct deposit and virtual card payment (VCP). Both options are facilitated by Optum Pay, a full-service payment and remittance solution. You can learn more about these options on our Electronic payment options page.

Using EDI for all eligible UnitedHealthcare transactions can help your organization improve efficiency, reduce costs and increase cash flow. You can find more information and resources on our EDI page.

A PRA is generated for every processed claim and includes relevant details about how the claim was processed. You can access them a variety of ways, including Document Library, Electronic Data Interchange (EDI) or Application Programming Interface (API). Learn more in our PRA Overview.