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Verifying Eligibility and Effective Dates - Capitation and/or Delegation Supplement, 2018 UnitedHealthcare Administrative Guide

Check the member’s eligibility and benefits prior to rendering services. This helps ensure that you submit the claim to the correct payer, collect copayments, determine if a referral and prior authorization or notification is required and reduces denials for non-coverage.

There are three easy ways to verify eligibility and benefits:

  • EDI: Transactions 270 (Inquiry) and 271 (Response) through your vendor or clearinghouse
  • Online: eligibilityLink
  • Phone: 877-842-3210

We can provide you with daily member eligibility information using an electronic 834 file containing eligibility changes. We can provide a full eligibility file monthly. You must coordinate initiation of electronic eligibility files with your software vendor and us. Some of the advantages of receiving electronic eligibility are:

  • An eligibility upload may reduce your costs by reducing the effort required to maintain eligibility manually.
  • Eligibility updates can be loaded into your system in a timely manner.

Refer to the section titled ASC X12 Technical Report Type 3/ Companion Guides for more information, or ask your provider advocate.