Search

Online/interoperability resources and how to contact us - Chapter 1, 2022 UnitedHealthcare Administrative Guide

Going digital means less paper and more automation, faster workflow between applications and a quicker claims submission process to help you get paid faster. Learn the differences by viewing our Digital Solutions Comparison Guide. You will conduct business with us electronically. This means using electronic means, where allowed by law, to submit claims and receive payment, and to submit and accept other documents, including appeals requests and decisions and prior authorization requests and decisions. Using electronic transactions is fast, efficient, and supports a paperless work environment. Use EDI, the  UnitedHealthcare Provider Portal or API for maximum efficiency in conducting business electronically.

Application Programming Interface (API)

API is becoming the newest digital method in health care to distribute information to health care professionals and business partners in a timely and effective manner. API is a common programming interface that interacts between multiple applications. Our API solutions allow you to electronically receive detailed data on claims status and payment, eligibility and benefits, claim reconsiderations and appeals (with attachments), prior authorization, referrals and documents. Information returned in batch emulates data in the UnitedHealthcare Provider Portal and complements EDI transactions, providing a comprehensive suite of services. It requires technical coordination with your IT department, vendor or clearinghouse. The data is in real time and can be programmed to be pulled repetitively and transferred to your practice management system or any application you prefer. For more information, visit uhcprovider.com/api.

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 health 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 health 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.

The following are EDI transactions available to health care providers:

  • 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.

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.

uhcprovider.com

uhcprovider.com is your home for health care provider information with access to Electronic Data Interchange (EDI), Application Programming Interface (API), the UnitedHealthcare Provider Portal tools, medical policies, news bulletins, and great resources to support administrative tasks including eligibility, claims, claims status and prior authorizations and notifications.

UnitedHealthcare Provider Portal

The  UnitedHealthcare Provider Portal provides online resources to support your administrative tasks including eligibility, claims and prior authorization and notifications.

To sign in to the UnitedHealthcare Provider Portal, go to uhcprovider.com and click on Sign In in the upper right corner. For more information about all UnitedHealthcare Provider Portal online solutions, go to uhcprovider.com > Menu > Resource Library >  UnitedHealthcare Provider Portal.

Use the UnitedHealthcare Provider Portal to access information for the following:

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

Available benefit plan information varies for each of our  UnitedHealthcare Provider Portal tools.

Here are the most frequently used tools:

  • Eligibility and Benefits — View patient eligibility and benefits information for most benefit plans. For more information, go to uhcprovider.com/eligibility.
  • Claims — Get claims information for many UnitedHealthcare plans, including access letters, remittance advice documents and reimbursement policies. For more information, go to uhcprovider.com/claims.
  • 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 drugs by selecting the Prior Authorization dropdown in the  UnitedHealthcare Provider Portal landing page. You will be directed to Prior Authorization and Notification capability to complete your requests.
  • My Practice Profile — View and updateyour health care provider demographic data that UnitedHealthcare members see for your practice. For more information, go to uhcprovider.com/mpp.
  • Document Library — Access reports and correspondence from many UnitedHealthcare plans for viewing, printing or download. For more information on the available correspondence, go to uhcprovider.com/documentlibrary.
  • Paperless Delivery Options — Eliminate paper mail correspondence. In Document Library, you can set up daily or weekly email notifications to alert you when we add new letters to your Document Library. With our delivery options, you decide when and where the emails are sent for each type of correspondence. This tool is available to One Healthcare ID password owners only.

You need a One Healthcare ID to access the UnitedHealthcare Provider Portal. To register for a One Healthcare ID, go to uhcprovider.com/newuser.

1 For more instructions, visit uhcprovider.com/training.

Watch for the most current information about our online resources by email (sign up at uhcprovider.com/subscribe), or online at uhcprovider.com/edi or uhcprovider.com > Menu > Resource Library > UnitedHealthcare Provider Portal.

Online resources and how to contact us:

Expand All add_circle_outline

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 health 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.
  • Access virtual card payment statements

UnitedHealthcare Web Support: providertechsupport@uhc.com or 1-866-842-3278 option 1 Monday-Friday, 7 a.m. - 9 p.m. CT

(To submit and Get Status Information)

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)

1-888-478-4760 (Individual Exchange Plans)

See member’s ID card for specific service contact information.

For Individual Exchange Plans, call 1-888-478-4760.

(Commercial members)

(Medicare Advantage – follow the directions in the customer decision letter)

All Savers, 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 For Individual Exchanges:

Urgent medical fax: 1-888-808-9123

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. Click Sign In in the upper right corner.

Information: UHCprovider.com/claims (policies, instructions and tips)

Phone:

1-877-842-3210 (follow the prompts for status information)

1-888-478-4760 (Individual Exchange Plans)

 

Where to go:

Onlineoptum.com/optumpay

Help Desk: 1-877-620-6194

Where to go:

OnlineUHCprovider.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 or the number listed on the back of the member’s ID card

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

API: Referral API details are online at uhcprovider.com/api

Online: uhcprovider.com. Sign in to the UnitedHealthcare Provider Portal at uhcprovider. com and click Sign In in the upper right corner.

Information: uhcprovider.com/referrals

Note: Submitted referrals are effective immediately but may not be viewable for 48 hours.

(Free-standing)

Where to go:

Online: UHCprovider.com/skillednursing

Phone: 

1-877-842-3210 (for Provider Service)

1-888-478-4760 (Individual Exchange Plans)

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:

For Commercial members:

Online: uhcprovider.com > Menu > Prior Authorization and Notification > Oncology > Radiation Therapy Services

Phone: 1-888-397-8129

For Medicare Advantage members:

Online: uhcprovider.com > Prior Authorization and Notification > Oncology > Medicare Advantage Therapeutic Radiation

Phone: 1-866-889-8054

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.