Our Claims Process - Chapter 9, 2018 UnitedHealthcare Administrative Guide

Prompt Claims Processing

We know that you want prompt payment. We work hard to process your claims timely and accurately. This is what you can do to help us:

  1. Submit the claim to the correct payer by reviewing the member’s eligibility as outlined in Verifying Eligibility, Benefits, and Your Network Participation Status.  
Claim Tools & Resources

Visit the Claims section to learn more about the many tools available to help you prepare, submit and manage your UnitedHealthcare claims including: Claim Estimator with bundling logic, training tools and resources including Frequently Asked Questions (FAQs), Quick References, Step-by-Step instructions and tutorials.

Note: When we give you eligibility and benefit information we are not guaranteeing payment or coverage in any specific amount. Actual reimbursement depends on many factors, such as compliance with administrative protocols, date(s) of services rendered, and benefit plan terms and conditions. For MA benefit plans, reimbursement also depends on CMS guidance and claims processing requirements.

2.  Follow the instructions in the How to Submit Advance or Admission Notifications/Prior Authorizations section.

3 . Prepare complete and accurate claims (see Claims and Encounter Data Submissions section or use our
     reference guides found on UHCprovider.com/claims).

4.  Submit claims electronically for fast delivery and confirmation of receipt.

         a.  Electronic submissions are preferred for sending claims to UnitedHealthcare. View our Claims Payer List
              to determine the correct Payer ID to use.
         b.  Our contracts generally require you to conduct business with us electronically. They contain specific
              requirements for electronic claim submission. Please review your agreement with us and follow the
              requirements. While some claims may require supporting information for initial review, we have reduced
              the need for paper attachments. We request additional information when needed.
         c.  For helpful resources and tips on submitting claims electronically, visit UHCprovider.com/EDI.
         d.  To check the status of a claim, EDI 276/277 Claim Status Inquiry and Response transactions are
               available through your vendor or clearinghouse.
         e.  If you need additional information on EDI, visit our EDI Contacts page.