Our claims process - 2021 UnitedHealthcare Administrative Guide

UMR/UHSS claims, benefits and eligibility are not available on UHCprovider.com. Refer to the How to contact UMR setion of the UMR supplement for tools and resources.

UMR

  • Online: umr.com
  • Phone: Call the number listed on the back of the member ID card or dial 1-877-233-1800.
  • Mail: Use the address listed on the back of the member ID card.

For UnitedHealthcare Shared Services (UHSS)

Contact information is listed on the back of the member ID card.

Overpayments for UMR

If we inform you of an overpaid claim that you do not disagree with, send us the refund check within 30 calendar days (or as required by your Agreement) from the date of notification.

We may apply the overpayment against future claim payments, unless your Agreement states otherwise. If an overpayment is eligible for recoupment, UMR will attempt to recoup the overpayment for 120 days. If recoupment is unsuccessful, there is no activity within 120 days, or the customer and/or care provider opted out of the recoupment process, the overpayment will be sent to Payment Resolution Solutions for recovery assistance. In some situations, we may handle overpayment recoveries internally, or the customer may use their own overpayment vendor for recoveries. If you identify an overpaid claim, send the refund along with the Overpayment Refund/Notification Form to the following address:

UMR
PO Box 30541
Salt Lake City, UT 84130-0541

For overpayment questions, call 1-877-233-1800 or the customer service number listed on the back of the member ID card.

Claim reconsideration and appeals process

If you disagree with the outcome of a processed claim (payment, correction or denial), you can complete the Claim Reconsideration Request Form and check “Previously denied/closed for additional information” as your reason for request.

Include the following information on the form to prevent processing delays:

  • Member name.
  • Member ID number.
  • Provider name, address and TIN.
  • Attach all supporting materials to the request, including member specific treatment plans or clinical records. The decision is based on the materials you provide.

UMR

Fax: 1-877-291-3248

Mail:

UMR- Claim Appeals
PO Box 30546
Salt Lake City, UT 84130-0546

(or send to the address listed on the provider ERA)

Phone: Call the number listed on the back of the member ID card.

For UnitedHealthcare Shared Services (UHSS):

Mail:

UHSS
PO Box 30783
Salt Lake City, UT 84130-0783