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 Portalor 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 Portaland 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:
Eligibility and benefits (270/271)
Claims status (276/277)
Referrals and authorizations (278)
Hospital admission, discharge and observation stay notifications (278N)
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 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.
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 Portallanding page. You will be directed to Prior Authorization and Notification capability to complete your requests.
My Practice Profile — View and update1 your 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.
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.
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.