Claims and Payments

If you are not satisfied with the outcome of a Claim Reconsideration Request, you may submit a formal Claim Dispute/Appeal using the process outlined in your provider manual.

• A formal Claim Dispute/Appeal is a comprehensive review of the disputed claim(s), and 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 will contact you if we believe it will take longer than 30 days to render a decision.
• Please allow 10 business days from the submission date to enable us to begin processing the review before requesting a status update.

Additional state requirements may apply. Please consult the applicable state Provider Administrative Guide or Manual for more details or contact the provider services center.

To view up to date claim reconsideration information go to UHCprovider.com/claims.

• Single Paper Claim Reconsideration Form
  

Direct deposit and VCP information is available to EPS-enrolled care providers in the Electronic Payments & Statements (EPS) tool.

Using Electronic Data Interchange (EDI) for all eligible UnitedHealthcare transactions can help your organization improve efficiency, reduce costs and increase cash flow. We encourage you to use the following tools and resources to help you get started with electronic transactions.

A PRA is generated for every processed claim and includes relevant details about how the claim was processed.