Admission notification required to avoid reduced reimbursement
Help ensure your facility is fully reimbursed by taking the necessary steps for member admission and following the required notification timeline
Beginning Sept. 1, 2025, we will enhance enforcement of our policy to reduce your reimbursement amount if we receive the admission notification late or not at all. Note: We do not apply reductions for maternity admissions. We apply reductions for post-acute inpatient admissions on our commercial plans, but we do not apply them on our MA plans.
You may not balance bill the member for the reimbursement reduction. The amount reduced depends on the following:
Admission notification timeline | Reimbursement reduction |
---|---|
Between 24 and 72 hours of admission | 100% of the average daily contract rate* for the days preceding notification |
After 72 hours of admission | 100% of the contract rate (entire stay) |
No admission notification received | 100% of the contract rate (entire stay) |
* The average daily contract rate is calculated by dividing the contract rate for the entire stay by the number of days for the entire length of stay.
What this means for your facility
According to your UnitedHealthcare Participate Agreement, you’re required to notify us within a specific timeline when a member is admitted into your facility:**
Time of admission | Standard notification requirements |
---|---|
Weekdays | Within 24 hours |
Weekends and holidays | By 5 p.m. local time on the next business day |
Emergencies | Within 24 hours, or the next business day if on a weekend/holiday, from the time coverage information is known |
** Exact requirements could vary for some facilities based on non-standard provider contract language or a state specific regulation.
The timely admission notification requirement applies to our commercial, Individual Exchange plans, also referred to as UnitedHealthcare Individual & Family ACA Marketplace, and Medicare® Advantage plans.
How to avoid reimbursement penalties
Take these steps to help ensure your facility is fully reimbursed for a member’s stay:
- Verify member eligibility and benefits before admission
- Complete the admission notification with all required information
- Electronically notify us of the member’s admission within the required timeline
Admission notification does not ensure payment. Payment for covered services depends on the member’s benefits, facility’s contract, claim processing requirements and eligibility for payment.
How to verify member eligibility and benefits
You can verify member eligibility and determine member benefits through the UnitedHealthcare Provider Portal:
- Go to UHCprovider.com and click Sign In at the top-right corner
- Enter your One Healthcare ID and password
- New users who don’t have a One Healthcare ID: Visit UHCprovider.com/access to get started
- Select Eligibility and enter your search criteria
For detailed instructions, go to our Eligibility and Benefits interactive guide.
How to send notifications
You must send admission notifications electronically using one of the methods below. We will not accept them by phone or fax, except in states where required by law.
- UnitedHealthcare Provider Portal
You can access the Prior Authorization and Notification tool through the UnitedHealthcare Provider Portal:- Go to UHCprovider.com and click Sign In at the top-right corner
- Enter your One Healthcare ID and password
- New users who don’t have a One Healthcare ID: Visit UHCprovider.com/access to get started
- In the menu, select Prior Authorizations
For detailed instructions, go to the admission notification section of our Prior Authorization and Notification interactive guide.
- Electronic funds transfer (EFT)
Use EFT transaction 278N to notify us of facility admissions
If you practice in Maryland
See the Provider Administrative Guide for notification requirements for elective inpatient procedures.
Resources
Refer to the “Facilities: standard notification requirements” section of the 2025 UnitedHealthcare Care Provider Administrative Guide for Commercial, Individual Exchange and Medicare Advantage for detailed information.
Questions? We're here to help.
Connect with us through chat 24/7 in the UnitedHealthcare Provider Portal.
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