Frequently asked questions (FAQs) - 2021 UnitedHealthcare Administrative Guide

Timely filing requirements are determined by the self-funded customer as well as the provider-contracted timely filing provisions. You must file the claim within the timely filing limits or we may deny it. If you dispute a claim that was denied due to timely filing, you must submit proof that you filed the claim within the timely filing limits. Timely filing limits vary based on your contract and/ or the self-funded benefit plan.

Our processes are basically the same. As a TPA, we work to customize the health care needs of the customer. Differences are in the types of services selected as part of the administration, the level of benefits at which covered services are processed and the services covered. Examples of services available include medical and dental claim administration, flexible spending account (FSA), pharmacy benefit manager (PBM), stop loss carriers, vision plans, care management, case management, utilization management and disease management.

We follow the same modifier/bundling edits developed by UnitedHealthcare for the UnitedHealthcare networks. Go to UHCprovider.com/policies to review applicable reimbursement policies. For customers not accessing UnitedHealthcare networks, we follow Ingenix Code Claim Edit Review.

We use the American National Standards Institute (ANSI) denial codes and definitions.

We have a dedicated customer service line. UnitedHealthcare cannot transfer these calls.

Our Interactive Voice Response (IVR) system number is 1-877-233-1800. The IVR system offers information through faxback. If you have additional questions, the faxback contains a passcode and number to call to speak with a representative.

Visit umr.com to access claim information and obtain the phone number and passcode, which will allow you to speak with a representative.

Go to umr.com. On the first visit, you will need to register your tax identification number (TIN). The website is an efficient way to check claim status, obtain benefits and much more. Be sure all TINs used are registered. If you have trouble registering, call Technical Support at 1-866-922-8266.

Note: This is a secure website for UMR member claim and benefit information.

  • Preauthorization
  • Dental claim
  • Electronic remittance advice (ERA)
  • UMR post-service appeal request
  • Various clinical request forms

Yes. You can search using the member’s Social Security Number, and the results will include the member’s unique health plan ID number. Due to HIPAA requirements, we will not show the Social Security Number online.

  1. Log into umr.com > Enter the member ID number > Select the family member > Select summary view > Select search > Click search
  2. Go to “Need additional information on this member?” > Click on “provider service center.” The passcode will be provided.
  3. Call 1-877-233-1800, follow the prompts and enter the passcode to speak with a representative.

Yes. UMR Customer First Representatives (CFRs) can address claim adjustments over the phone, depending on the claim details. CFRs cannot change a claim if inappropriate modifiers or CPT/HCPCS codes are listed. Such issues require a resubmission of the claim with corrected codes from the servicing care provider. Note: CFRs cannot advise you on how to bill.

The primary network(s) are listed on the front of the member’s ID card.

Go to umr.com or call 1-877-233-1800.

We can initiate the check tracer process 30 days after the check was issued. After the check tracer has been initiated, we work with the employer group to verify if the check has been cashed. This process can take up to an additional 30 days.

Return the letter request with the medical records. This will help ensure the records are routed to the correct department for review and prevent any potential delays. Do not re-submit the original claim with the medical records.

At UMR, claims are denied for additional information (not pended).

Medical records can be submitted using the following 3 options:

  • Online: umr.com
  • Fax: Use the fax number noted on the request letter.
  • Mail: Use the mailing address noted on the request letter.

Medicaid is responsible to bill UMR for reimbursement of what was previously paid to you.

If Medicaid returns the UMR payment, we can reconsider your claim at that time. Our customer plan provisions will apply.

Log into umr.com > Click “refund tracking” under myMenu > Enter financial control number (FCN).

All FCNs must be 11 digits long. The FCN is located on the remittance advice.

Log into umr.com > Select Advanced claims under myMenu > Select Check number > Enter the 10 digit check number > Enter the group number > Click Search.

The results will show all claims paid on the given check. You can call the customer service number on the back of the ID card to request a copy or the remit sent to them.

UMR will keep the provider on dual delivery of both for 6 months.

If the provider would like to stop the dual delivery, log into umr.com > Select Provider > Select Find a Form and select the electronic paper remittance advices request form.

EFT enrollment does not guarantee that all payments coming from UMR will be sent using this electronic option. EFT approval must also be received from UMR customer groups. UMR is a TPA paying claims from each customer’s bank account.

Note: There is no charge to the provider to enroll in the EFT/ERA process.

When UMR processes a claim, the check/EFT issue date will determine the date that the funds are sent to the electronic vendor. The electronic vendor will make a deposit into the provider’s account. This is typically 3-7 days after UMR sends the funds to the electronic vendor.

Important: The customer chooses which day of the week/month to release payment.