Here you will find the tools and resources you need to help manage your practice’s submission of claims and receipt of payments. Our self-service resources for claims include using Electronic Data Interchange (EDI) and the Claims tool in UnitedHealthcare Provider Portal.
UnitedHealthcare is launching initiatives to replace paper checks with electronic payments. As part of these efforts, we are encouraging both in-network and out-of-network providers to sign up for electronic payments, specifically by automated clearing house (ACH)/direct deposit. If you don’t elect to sign up for ACH/direct deposit, you may receive Virtual Card Payments in place of paper checks. The alternative to a Virtual Card Payment is direct deposit.
Virtual Card Payments are subject to the terms and conditions governing card processing between you and your card service processor, and you are responsible for any charges and related third party fees, including interchange, merchant discount, or other card processing fees. Consult your merchant processor or financial institution for the specific fees. Optum Financial™, a United-affiliated company, provides payment services to the healthcare industry and offers various claim payment options. United-affiliated companies may receive transaction fees or other compensation related to some payment options.
Florida, Louisiana, New Mexico, New York or Oregon out-of-network providers and all Colorado, Georgia, and New Jersey providers have to consent to receive a virtual card payment.
Processing of the Virtual Card Payment is your consent to receive and accept it as payment in full from the payer. If you don’t consent, when you receive a Virtual Card Payment, please call the number provided on your Virtual Card Payment to arrange an alternative payment method.
You should submit an Appeal using the File Appeal button in Claims tool when available, should you wish to challenge a decision or request an exception. Situations for reprocessing include, but are not limited to:
Medical necessity (must be filed as a member appeal and can be submitted by the member or by the provider on their behalf)
Need a paper form because you are unable to submit your appeal online?
Quickly receive an estimate of a UnitedHealthcare Commercial claim reimbursement and share the estimated cost of a procedure with your patient before treatment. Use claim bundling logic for professional claims and determine how the CPT or HCPCS codes will be paid.
Direct Connect is a free online tool that helps you review and resolve overpaid claims quickly and easily. Using Direct Connect, you can track and manage overpayment requests, dispute an overpayment finding and submit refunds – reducing the letters and calls you receive from UnitedHealthcare, or the need to work with third-party vendors.
Direct Connect is available on the UnitedHealthcare provider portal. To get started, simply email email@example.com. Please include the requestor’s name as well as the organization’s TIN(s), physical address and mailing address.
Optum Pay lets you select your payment method, view payments, search remittances, print Electronic Remittance Advices (ERAs) and more. Enrolling online is simple and easy. Before you begin have the following handy:
Bank account and routing numbers for direct deposit
A voided check or bank letter to verify bank account information
Look up contracted rates for CPT and HCPCS codes whose rates are dollar amounts or a percentage of charges for a specific provider and name. (Available only for Commercial and some Community Plan states.)
Physician Fee Source Links
As referenced in the Market Standard Pricing Schedule (MSPS) Payment Appendix Document, information about our Physician Fee Schedule Fee Sources can be located at:
OneNet PPO maintains the OneNet PPO Workers’ Compensation Network, a network of physicians, health care practitioners, hospitals and ancillary facilities used for work-related illness and injury. The network serves workers’ compensation programs administered by employers and TPAs contracted with Procura, an Optum Company.
For information about OneNet PPO and OneNet workers’ compensation claim pricing sheets for Procura, access the OneNet PPO Pricing.
If the Health Plan forwarded claims to you that you believe are the Health Plan’s responsibility according to the Division of Financial Responsibility (DOFR), please return the claims with the appropriate cover sheet below. This will ensure the claims get to the correct team for processing: