For ASIC members, submit electronic claims using Payer ID number 81400. Submit paper claims to the address on the member’s ID card.
For contracted health care providers who submit electronic claims and would like to receive electronic payments and statements, call Optum Financial Services Customer Service line at 1-877-620-6194 or visit optumbank.com > Partners >
Claim reimbursement (adjustments)
If you think your claim was processed incorrectly, call the number on the member’s ID card. If you find a claim where you were overpaid, send us the overpayment within 30 calendar days. If we find a claim was overpaid, payment is due within 30 calendar days.
If you disagree with our decision regarding a claim adjustment, you may appeal.
Claim reconsideration, appeals and disputes
Claim reconsideration does not apply to some states based on applicable state legislation (e.g., Arizona, California, Colorado, New Jersey or Texas). For states with applicable legislation, any request for dispute will follow the state-specific process.
There is a 2-step process available for review of your concern. Step 1 is a Claim Reconsideration. If you disagree with the outcome of the Claim Reconsideration, you may request a Claim Appeal (step 2).
How to submit your reconsideration or appeal
If you disagree with claim payment issues, overpayment recoveries, pharmacy, medical management disputes, contractual issues or the outcome of your reconsideration review, send a letter requesting a review to:
P.O. Box 31371
Salt Lake City, UT 84131-0371
Standard Fax: 1-801-478-5463 Phone: 1-800-291-2634
If you feel the situation is urgent, request an expedited appeal by phone, fax, or writing:
2020 Innovation Dr.
DePere, WI 54115
You must submit your claim reconsideration and/or appeal to us within 12 months (or as required by law or your Agreement), from the date of the original EOB or denial. The 2-step process allows for a total of 12 months for timely submission, not 12 months for step 1 and 12 months for step 2.
What to submit
As the health care provider of service, you submit the dispute with the following information:
Member’s name and health plan ID number
Specific item in dispute
Clear rationale/reason for contesting the determination and an explanation why the claim should be paid or approved
If you disagree with the outcome of the claim appeal, you may file for an arbitration proceeding. A description of this process is in your Agreement.
To verify ASIC members’ benefits, call the number on the back of the member’s ID card.
ASIC uses tools developed by third parties, such as InterQual Care Guidelines, to help manage health benefits and to assist clinicians in making informed decisions.
As an affiliate of UnitedHealthcare, ASIC may also use UnitedHealthcare’s medical policies as guidance. These policies are available on uhcprovider.com/policies.
Notification does not guarantee coverage or payment (unless mandated by law). We determine the member’s eligibility. For benefit or coverage information, call the phone number on the back of the member’s ID card.
Michigan law regarding diabetes
Michigan law requires us to provide coverage for some diabetic expenses. It also requires us to establish and provide a program to help prevent the onset of clinical diabetes. We have adopted the American Diabetes Association (ADA) Clinical Practice Guidelines.
The program focuses on best practices to help prevent the onset of clinical diabetes and to treat diabetes, including, but not limited to, diet, lifestyle, physical exercise and fitness, and early diagnosis and treatment. Find the Standards of Medical Care in Diabetes and Clinical Practice Recommendations atcare.diabetesjournals.org.
Subscription information for the American Diabetes Journals is available on the website above or by calling 1-800-232-3472, 8:30 a.m. – 8 p.m. ET, Monday–Friday. Journal articles are available without a subscription at the website listed above.