UHCprovider.com
UHCprovider.com is your home for care provider information with access to Electronic Data Interchange (EDI), Application Programming Interface (API), Link self-service tools, medical policies, news bulletins, and great resources to support administrative tasks including eligibility, claims, claims status and prior authorizations and notifications.
Point of Care AssistTM
When made available by UnitedHealthcare, you will do business with us electronically. Point of Care Assist integrates members’ UnitedHealthcare health data within the Electronic Medical Record (EMR) to provide real-time insights of their care needs, aligned to their specific member benefits and costs. This makes it easier for you to see potential gaps in care, select labs, estimate care costs and check prior authorization requirements, including benefit eligibility and coverage details. This helps you to better serve your patients and achieve better results for your practice. For more information, go to UHCprovider.com/poca.
Electronic Data Interchange (EDI)
EDI is a self-service resource using your internal practice management or hospital information system to exchange transactions with us through a clearinghouse.
The benefit of using EDI is it permits care providers to send batch transactions for multiple members and multiple payers in lieu of logging into different payer websites to manually request information. This is why EDI is usually care providers’ first choice for electronic transactions.
EDI transactions available to care providers are:
Visit UHCprovider.com/edi for more information. Learn how to optimize your use of EDI at UHCprovider.com/optimizeEDI.
Getting started
Application Programming Interface (API)
Our API solutions allow you to electronically receive detailed data on claims status and member eligibility and benefits. Information returned in batch emulates data in Link and complements EDI transactions, providing a comprehensive suite of services. You can transfer data to your practice management or hospital information system by your vendor or IT resources.
Learn more at UHCprovider.com/api.
Link
Link provides online resources to support your administrative tasks including eligibility, claims and prior authorization and notifications.
To sign in to Link, go to UHCprovider.com and click on Sign in to Link in the upper right corner. For more information about all Link tools, go to UHCprovider.com/link.
You will conduct business with us electronically. Using electronic transactions is fast, efficient, and supports a paperless work environment. Use EDI, Link or API for maximum efficiency in conducting business electronically.
Use Link to access information for:
Available benefit plan information varies for each of our Link tools. Here are the most frequently used tools:
You need an Optum ID to access Link and use tools available to you. To register for an Optum ID, go to UHCprovider.com/ newuser.
Watch for the most current information on our self-service resources by email (sign up at UHCprovider.com/subscribe), or online at UHCprovider.com/edi or UHCprovider.com/link.
Where to go:
For instructions on joining the UnitedHealthcare provider network, go to UHCprovider.com/join. There you will find guidance on our credentialing process, how to sign up for self-service tools and other helpful information.
Where to go:
UHCprovider.com Resources:
UnitedHealthcare Web Support: providertechsupport@uhc.com or 1-866-842-3278 (option 1 for UHCprovider.com and Link assistance). Monday-Friday, 7 a.m. - 9 p.m. CT
Where to go:
EDI: See EDI transactions and code sets on UHCprovider.com/edi Online: UHCprovider.com/paan
Phone: 1-877-842-3210 (United Voice Portal)
See member’s ID card for specific service contact information.
Where to go:
Online: UHCprovider.com/findprovider
(Commercial members)
(Medicare Advantage – follow the directions in the customer decision letter)
All Savers, UnitedHealthcare Level Funded, UnitedHealthcare Oxford Level Funded, Golden Rule Insurance Company and UnitedHealthcare Oxford Navigate Individual
Where to go:
An expedited appeal may be available if the time needed to complete a standard appeal could seriously jeopardize the member’s life, health or ability to regain maximum function.
Urgent medical fax: 1-801-994-1083
Urgent pharmacy fax: 1-801-994-1058
Urgent appeal fax: 1-866-654-6323
Notification/Prior Authorization - Submission and Status
Where to go:
Online: UHCprovider.com/priorauth and select the specialty you need.
Phone: 1-866-889-8054
(Contracted with Optum Physical Health, a UnitedHealth Group company)
Where to go:
Online: myoptumhealthphysicalhealth.com Phone: 1-800-873-4575
(Filing, payments, reconsiderations)
Where to go:
EDI: UHCprovider.com/edi837 Learn more about the types of claims you can file using EDI and view our claims payer list to identify the correct Payer ID.
Online: UHCprovider.com/link
Information: UHCprovider.com/claims (policies, instructions and tips)
Phone: 1-877-842-3210 (follow the prompts for status information)
Where to go:
Online: UHCprovider.com/edi
Help: UHCprovider.com/edicontacts
Phone: 1-800-842-1109 (Monday-Friday, 7 a.m. – 9 p.m. CT)
UnitedHealthcare EDI Support
Online: EDI Transaction Support Form Email: supportedi@uhc.com
Phone: 1-800-842-1109
UnitedHealthcare Community Plan EDI Support Online: EDI Transaction Support Form
Email: ac_edi_ops@uhc.com Phone: 1-800-210-8315
(Report potential fraud, waste or abuse concerns)
Where to go:
Online: uhc.com/fraud, select the “Report A Concern” icon.
Phone: 1-844-359-7736
Phone: 1-877-842-3210 (United Voice Portal)
For more information on fraud, waste and abuse prevention efforts, refer to Chapter 17: Fraud, Waste and Abuse.
Where to go:
Online: UHCprovider.com/priorauth and select the specialty you need.
Where to go:
Online: myuhc.com Phone: 1-877-842-3210
Where to go:
See member’s ID card for carrier information and contact numbers.
Where to go:
Online: UHCprovider.com/priorauth and select the specialty you need.
Phone: 1-888-397-8129
Where to go:
Online: professionals.optumrx.com Phone: 1-800-711-4555
For participating hospitals, health care, and ancillary providers; Locate your physician or hospital advocate
Where to go:
Online: UHCprovider.com > Contact Us > Find a Network Contact
Where to go:
You can determine if a member’s benefit plan requires a referral when you view their eligibility profile.
Where to go:
EDI: 278 transaction
Online: UHCprovider.com/link Information: UHCprovider.com/referrals
Note: Submitted referrals are effective immediately but may not be viewable for 48 hours.
Where to go:
Online: UHCprovider.com/skillednursing Phone: 1-877-842-3210 (for Provider Service)
Where to go:
Online: subroreferrals.optum.com Fax: 1-800-842-8810
Mail: Optum
11000 Optum Circle MN102-0300
Eden Prairie, MN 55344
Where to go:
Online: UHCprovider.com/oncology > Commercial Intensity Modulated
Radiation Therapy Prior Authorization Program
UHCprovider.com/oncology > Medicare Advantage Therapeutic Radiation Prior Authorization Page
Phone: 1-866-889-8054 (MA only)
Where to go:
See member’s ID card for carrier information and contact numbers.
Where to go:
See member’s ID card for carrier information and contact numbers.