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 the claim. 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 similar to UnitedHealthcare. 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.
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.
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.
Yes. UMR 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 health care provider. CFRs cannot advise you on how to bill.
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:
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.