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 in with your One Healthcare ID.
Are you a member looking for a provider?
Find in-network providers at myuhc.com.
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 guide 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.
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.
Explore 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 overview 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®, a full-service payment and remittance solution used by all sizes and types of health care organizations. Learn how to enroll.
Automated Clearing House (ACH)/direct deposit
Learn more about this option, also known as electronic funds transfer (EFT), in our enrollment guide. 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 guide walks you through the enrollment process.
Claims and billing interactive guide
View claim status, take action (if needed), check the status of tickets and more.
Claims reconsideration quick start guide
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
Learn how to check your claims status and payment information without mailing or faxing.
TrackIt interactive guide
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
Claims overpayment refund/notification form – single or multiple
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 claim
Skip the reconsideration form and submit your claim reconsideration electronically through the UnitedHealthcare Provider Portal. 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.
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
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 guide 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.
Batched items or services guidance
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.
News
November 14, 2024
Dec. 1: Electronic reconsideration and appeal submissions required
Health care professionals must submit Medicaid medical reconsiderations and appeals electronically in Louisiana and Pennsylvania.
November 14, 2024
New York Medicaid: Enroll with state to avoid claim denials
UnitedHealthcare will deny claims from health care providers who aren’t enrolled with the state Medicaid program. See why.
November 08, 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.
October 31, 2024
Change to UnitedHealthcare Community Plan of New York non-covered codes list
Starting Nov. 1, 2024, UnitedHealthcare Community Plan will add CPT code 82652 to its list of non-covered Medicaid codes.
October 31, 2024
Verify address to avoid APWUHP claim appeal delays
Claim appeals addressed incorrectly may be delayed or go unanswered. And APWUHP members to be assigned a new group number.
October 31, 2024
New Jersey Medicaid: Unbundle maternity codes to avoid claim denials
Global billing isn’t permitted in New Jersey for maternity care services. See how to avoid claim denials.