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Claims, Billing and Payments

Here you will find the tools and resources you need to help manage your practice’s submission of claims and receipt of payments. Your primary UnitedHealthcare claims resource, the claimsLink app, is available on Link, the gateway to UnitedHealthcare’s self-service tools.

Direct deposit and virtual card payments (VCP) information is available on Link in the Electronic Payments & Statements app, if you are enrolled.

What Would You Like to Do?

To see more information on any of these areas, click on the plus sign (+) next to their title.

Submit a professional claim and receive a fully adjudicated claim value, as well as your patient's responsibility, based on contracted rates and plan benefits though UnitedHealthcareOnline.com. To learn more about other claim submission methods and connections, visit the EDI 837: Electronic Claims page for more information.

Claim Submission Quick Reference >

You can use the claimsLink app to submit a corrected claim or claim reconsideration and track claim reconsideration requests. It replaces the Claim Status and Claim Reconsideration options on UnitedHealthcareOnline.com and the Claims Management and Claims Reconsideration apps on Link. Need help with your reconsideration request, view Quick Reference: Claim Reconsideration - Corrected Claims.

Use the links on this page to access more resources or to go directly to the claimsLink app. 

More claimsLink Resources >

When Should You Submit a Claims Reconsideration?

You should submit a claims reconsideration request through claimsLink when you believe a claim was paid incorrectly. Situations for reprocessing include, but are not limited to:

  • Amount is different than what provider expected
  • Claim was filed in a timely manner, when provider has proof
  • Claim was denied for no authorization, when provider has an authorization number
  • Difference in Coordination of Benefits (COB) information 

Unable to access the claimsLink app and need a paper form to mail? Use our Single Paper Claim Reconsideration Request Form instead. 

When Should You Submit an Appeal?

You should submit an Appeal through claimsLink when you wish the 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) 

Where to Send Your Paper Appeal: Please send your request to the claim address on the back of the member's ID card.

Resources for Community Plan

The Claim Research Project app on Link lets you search for and submit a reconsideration request for multiple claims with the same reason for denial.

Are you a UHCWest care provider?

At this time, the Claim Research app on Link does not include support for UHCWest care providers. To submit multiple claims as a UHCWest care provider, please fill out and email both the Claims Project Management Request Form and the Multiple Claims Inquiry Spreadsheet found below to ProjectIntake@uhc.com.

The claimsLink app allows you to submit and track claim reconsideration requests. It replaces the Claim Status and Claim Reconsideration options on UnitedHealthcareOnline.com and the Claims Management and Claims Reconsideration apps on Link.

Use the links on this page to access more resources or to go directly to the claimsLink app.

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.

If you’re new to Claim Estimator, use the Claim Estimator Quick Reference to get started.

The Electronic Payments & Statements (EPS) app on Link 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, read the EPS Enrollment Instructions and have the following handy:

  • Bank account and routing numbers for direct deposit
  • A voided check or bank letter to verify bank account information
  • A copy of your practice or facility’s W-9 form

More EPS Resources >

For UnitedHealthcare West SignatureValue HMO and Medicare Advantage HMO claims use the UnitedHealthcare West EFT App. For help with enrollment, view the UnitedHealthcare West EFT Enrollment App Overview.

The UnitedHealthcare West Electronic Funds Transfer (EFT) Enrollment app allows you to enroll or make changes to EFT and 835s from the Link dashboard for your UnitedHealthcare West claims. Enrollment in UnitedHealthcare West EFT currently applies to payments from SignatureValue and Medicare Advantage plans.* You will continue to receive checks by mail until you complete your enrollment using the UnitedHealthcare West EFT app.

UnitedHealthcare West EFT Enrollment App Overview

With the UnitedHealthcare West EFT Enrollment app, you can:

  • Have claims payments deposited electronically into your designated bank account.
  • Make changes to an existing enrollment

Need Help with the UnitedHealthcare West EFT App?

For more information about EFT and ERA/835, click on the UnitedHealthcare West EFT tile on your Link dashboard. Email powrenrollment@uhc.com with questions about UnitedHealthcare West EFT. For questions about ERA/835, call 866-367-9778, option 1.

Click here for more information about Link. If you have questions, call UnitedHealthcare Connectivity Help Desk at 866-842-3278, option 3. They're available from 7 a.m. to 9 p.m. Central Time, Monday through Friday.

*UnitedHealthcare West EFT Enrollment and Electronic Payments and Statements (EPS) are two separate apps for different health plans. Use the UnitedHealthcare West EFT app for Signature Value and Medicare Advantage plans only. See page 2 of the EPS Flyer to learn which plans participate with EPS.

 

Electronic Payments & Statements Link Tile

The Electronic Payments & Statements (EPS) app on Link lets you select your payment method, view payments, search remittances, print Electronic Remittance Advices (ERAs) and more.

More information about EPS >

For UnitedHealthcare West SignatureValue HMO and Medicare Advantage HMO claims use the UnitedHealthcare West EFT App

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 App on Link.

If you are new OneNet PPO Pricing, use the OneNet PPO Pricing Status Quick Reference to get started.

The Electronic Payments & Statements (EPS) app on Link lets you select your payment method, view payments, search remittances, print Electronic Remittance Advices (ERAs) and more.

Use the following links to go directly to the EPS app or to see more information about EPS.

For UnitedHealthcare West SignatureValue HMO and Medicare Advantage HMO claims use the UnitedHealthcare West EFT App >

The Electronic Payments & Statements (EPS) app on Link lets you select your payment method, view payments, search remittances, print Electronic Remittance Advices (ERAs) and more.

Use the following links to go directly to the EPS app or to see more information about EPS.

For UnitedHealthcare West SignatureValue HMO and Medicare Advantage HMO claims use the UnitedHealthcare West EFT App >

The Electronic Payments & Statements (EPS) app on Link lets you select your payment method, view payments, search remittances, print Electronic Remittance Advices (ERAs) and more.

Use the following links to go directly to the EPS app or to see more information about EPS.

For UnitedHealthcare West SignatureValue HMO and Medicare Advantage HMO claims use the UnitedHealthcare West EFT App >

The Single Explanation of Benefit (EOB) Search is available to all care providers, including those not enrolled in Electronic Payments and Statements (EPS).

Use the OPG Exhibits to determine reimbursement for outpatient procedures. The exhibits list valid CPT/HCPCS codes and indicate which codes are eligible for reimbursement. If a code is eligible for reimbursement, then the grouper level is listed. The first tab shows the complete OPG Exhibit and the second tab lists the changes to impacted codes from one period to another. For your convenience, all available Exhibits are listed here.