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January 1, 2022 at 12:00 AM CT

Applicable to all states except NC.

Quick reference guide 2022 Administrative Guide

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If you are interested in joining our network, visit uhcprovider.com/join. To view our credentialing policies and procedures, visit uhcprovider.com > Menu > Resource Library > Join Our Network.

Credentialing application: Check on your application status by emailing networkhelp@uhc.com.

uhcprovider.comuhcprovider.com is your home for health care professional information with 24/7 access to the UnitedHealthcare Provider Portal, medical policies and news bulletins. The website offers great resources to support administrative tasks including eligibility, claims, referrals, and prior authorizations and notifications.

uhcprovider.com/digitalsolutions: Going digital means less paper and more automation, faster workflow between applications and quicker claims submission process to get you paid faster. Our 3 digital solutions, Electronic Data Interchange (EDI), Application Programming Interface (API) and the UnitedHealthcare Provider Portal, help to make that a reality, and it’s not a one-size-fits-all approach. There’s flexibility to choose the best approach for your practice, and there’s the ability to integrate with the practice management systems you use today. This webpage will help you choose the right solution to fit your practice’s needs.

uhcprovider.com/portal: Our portal allows you to quickly get the answers you need to claims information like status updates, reconsiderations and appeals. You can also submit prior authorization requests, check eligibility and benefits information, access items in Document Library (including virtual card payment statements) and even track your work, all at no cost to you and without having to make a phone call. To log in, click Sign In in the top right corner of uhcprovider.com.

uhcprovider.com/edi: Submit and receive data using HIPAA Electronic Data Interchange (EDI) X12 transactions for claim submissions, eligibility and benefits, claim status, authorizations, referrals, hospital admission, discharge and observation stay notifications and electronic remittance advice. You can submit single or batch transactions for multiple members and payers without manual data entry or logging into multiple payer websites.

uhcprovider.com/api: Our Application Programming Interface (API) solutions allow you to access comprehensive real-time data on a timetable you set. Data can be distributed to your practice management system, proprietary software or any application you prefer. We have APIs for claim status and payment, eligibility and benefits, reconsiderations and appeals, prior authorization, documents and referrals.

We provide a full range of training resources including interactive self-paced courses and instructor- led sessions at uhcprovider.com/training. The training content is organized by categories to make it easier to find what you need.

In order to access secure content on UHCprovider.com or to access Link self-service tools, you’ll need to create an Optum ID. Visit uhcprovider.com/access.

Network News: Find health care professional news and updates for national and state Commercial, Medicare and Medicaid plans at uhcvprovider.com/news.

Policy and Protocol Updates: News and updates regarding policy, product or reimbursement changes are posted online at uhcprovider.com/news. Updates are posted at the beginning of each month. Sign up to receive notification of these updates by email at uhcprovider.com/subscribe.

Most questions can be answered using our online solutions at uhcprovider.com. If you need to speak with someone, we’re here to help. For state-specific contact information, visit uhcprovider.com > Menu > Contact Us.
UnitedHealthcare Web Support 1-866-842-3278 providertechsupport@uhc.com
Provider Services 1-877-842-3210
Provider Services (Individual Exchange Plans) 1-888-478-4760
Prior Authorizations 1-877-842-3210
Prior Authorizations (Individual Exchange Plans) 1-888-478-4760
Optum PayTM Helpdesk 1-877-620-6194
Provider Agreement questions: Contact your Network Management representative. To identify your Network Management representative, go to uhcprovider.com > Menu > Contact Us > Find a Network Contact and select your state.
Provider Advocate: To find your health care provider advocate, go to uhcprovider.com > Contact Us > Find a Network Contact and select your state.

uhcprovider.com Menu > Find Dr.

  • Search for doctors, clinics or facilities by plan type.
  • Find dental providers by state, network or location.
  • Locate mental health or substance use services.

Access benefit, coverage and identification card information.
Online: UnitedHealthcare Provider Portal uhcprovider.com and click Sign In in the top right corner.
EDI: 270/271 transaction | uhcprovider.com/edi270
Phone: 1-877-842-3210
For Individual Exchange Plans, call 1-888-478-4760.

To notify us or request prior authorization:

API: Prior Authorization

  • Submit and check the status of prior authorizations using API.
  • View the implementation guide online at uhcprovider.com/apiguides.

EDI: Transactions 278 and 278N

  • Submit prior authorization requests and referrals using EDI 278 transactions. Go to uhcprovider.com/edi278 for more information.
  • Submit hospital admission, discharge and observation stay notifications using EDI 278N transactions. Go to uhcprovider.com/edi278n for more information.
  • Check the status of prior authorization requests and notifications at uhcprovider.com/edi278i.

Online: uhcprovider.com/paan

Use the Prior Authorization and Notification Tool on Link to:

  • Determine if notification or prior authorization is required.
  • Complete the notification or prior authorization process.
  • Select the Specialty Pharmacy Transactions tile on your Link dashboard. You will be directed to the new website we’re using to process these authorization requests.
  • Upload medical notes or attachments.
  • Check request status.

Information: uhcprovider.com/priorauth (information and advance notification/prior authorization lists)

Phone: Call Care Coordination at the number on the member’s ID card (self-service available after hours) and select “Care Notifications.”

EDI: uhcprovider.com/edi837 View our Claims Payer List to determine the correct Payer ID.

Online: uhcprovider.com/claimstool Click Sign In in the top 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)

Reimbursement Policies:

uhcprovider.com > Policies and Protocols > Commercial Policies > Commercial Reimbursement Policies

uhcprovider.com > Policies and Protocols > For Exchange Plans > Reimbursement Policies for UnitedHealthcare Individual Exchange Plans

uhcprovider.com > Policies and Protocols > Medicare Advantage Policies > Medicare Advantage Reimbursement Policies

uhcprovider.com > Policies and Protocols > Community Plan Policies > Reimbursement Policies for Community Plan

Reimbursement policies may be referred to in your Agreement as “payment policies.” Refer to the Medicare Advantage policies for DSNP members.

API: Submit reconsiderations and appeals with attachments using our API solution. Get more information online at uhcprovider.com/api.

Online: uhcprovider.com. Click Sign In in the top right corner.

Report escalated or unresolved issues to your Provider Advocate by email. Submit an appeal as a final resolution.

Medical Policies: Get copies of the medical policies and guidelines at uhcprovider.com/policies.

Refer to your internal contracting contact or Provider Agreement for timely filing information.

Care Provider or Group Demographic Information Update forms: uhcprovider.com/demographics > No Access to My Practice Profile?

Claims, Billing and Payment forms: uhcprovider.com/claims > Need a Paper Form?

Prior Authorization and Notification forms: uhcprovider.com/priorauth > Forms

uhcprovider.com > Menu > Find a Care Provider > Preferred Lab Network

Specialty Pharmacy Program provides focused support to help better manage rare and complex chronic conditions. Find details about the Specialty Pharmacy Program online at uhcprovider.com/ pharmacy > Specialty Pharmacy - Medical Benefit Management (Provider Administered Drugs).

Commercial medical benefit specialty prior authorizations are managed under the

Specialty Guidance Program (SGP).

Phone: 1-888-397-8129

Email: SpecialtyGuidanceProgram@optum.com