Online/interoperability resources and how to contact us - Chapter 1, 2021 UnitedHealthcare Administrative Guide

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.

  • Send and receive information faster
  • Identify submission errors immediately and avoid processing delays
  • Exchange information with multiple payers
  • Reduce paper, postal costs and mail time
  • Cut administrative expenses

EDI transactions available to care providers are:

  • Claims (837)
  • Eligibility and benefits (270/271)
  • Claims status (276/277)
  • Referrals and authorizations (278)
  • Hospital admission, discharge and observation stay notifications (278N)
  • Electronic remittance advice (ERA/835)

Visit UHCprovider.com/edi for more information. Learn how to optimize your use of EDI at UHCprovider.com/optimizeEDI.

Getting started

  • If you have a practice management or hospital information system, contact your software vendor for instructions on how to use EDI in your system.
  • Contact clearinghouses to review which electronic transactions can interact with your software system. Read our Clearinghouse Options page for more information.

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:

  • UnitedHealthcare Commercial
  • UnitedHealthcare Medicare Advantage
  • UnitedHealthcare Community Plan (as contracted by state)
  • UnitedHealthcare West
  • UnitedHealthcare of the River Valley
  • UnitedHealthcare Oxford Commercial

Available benefit plan information varies for each of our Link tools. Here are the most frequently used tools:

  • Eligibility and Benefits on Link — View patient eligibility and benefits information for most benefit plans. For more information, go to UHCprovider.com/link.
  • Claims on Link — Get claims information for many UnitedHealthcare plans, including access letters, remittance advice documents and reimbursement policies. For more information, go to UHCprovider.com/link.
  • Prior Authorization and Notification — Submit notification and prior authorization requests. For more information, go to UHCprovider.com/paan.
  • Specialty Pharmacy Transactions — Submit notification and prior authorization requests for certain medical injectable specialty drugs using the Specialty Pharmacy Transaction tile on your Link dashboard.
  • My Practice Profile — View and update* your provider demographic data that UnitedHealthcare members see for your practice. For more information, go to UHCprovider.com/mypracticeprofile.
  • Document Vault — Access reports and correspondence from many UnitedHealthcare plans for viewing, printing or download. For more information on the available correspondence, go to UHCprovider.com/documentvault.
  • Paperless Delivery Options — Eliminate paper mail correspondence. In Document Vault, you can set up daily or weekly email notifications to alert you when we add new letters to your Document Vault. With our delivery options, you decide when and where the emails are sent for each type of correspondence. This is available to Link password owners only.

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.

Online resources and how to contact us

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:

  • Access to care provider policies and protocols, tools, training and network news.
  • Enroll in Optum Pay for direct deposit for covered services and electronic remittance advice.
  • Authorizations and referrals information, submissions and status.
  • Verify eligibility and benefits.
  • Verify your network and tier status for a member’s benefit plan.
  • Claims management including filing, status information and claims reconsiderations.

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.

(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

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.