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UnitedHealthcare Provider Portal tools

Submit and track your claims, manage payments and get the details on Electronic Data Interchange for batch processing.

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Claims

View and submit claims and view, submit and flag reconsiderations; submit information on pended claims, and find confirmations and access letters, remittances advices and reimbursement policies.

Optum Pay

Enroll in Optum Pay, select payment method and view payments, search payment remittance and download and print remittance advices.

Additional payer tools

Learn about more tools and resources to support your practice's work with claims and payments.

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EDI

The Electronic Data Interchange (EDI) gives you an efficient electronic method for submitting and receiving batch transactions for multiple patients and payers.

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Resources

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Claims and billing training 
Interactive Guide: Use the UnitedHealthcare Provider Portal to view claim status, take action, if needed, check the status of tickets and more.

Claim Reconsideration Form - Single Claim
This form is to be completed by physicians, hospitals or other health care professionals for paper Claim Reconsideration Requests for our members.

Claims Overpayment Refund Form - Single or Multiple
Please complete this form and include it with your refund so that we can properly apply the check and record the receipt. If a check is included with this correspondence, please make it payable to UnitedHealthcare and submit it with any supporting documentation.

Point of Care Assist®
Point of Care Assist® (POCA) adds real-time patient information —including clinical, pharmacy, labs, prior authorization, eligibility and cost transparency — to your existing electronic medical records (EMRs) to make it easier for you to understand what patients need at the point of care.

Electronic Payment Solutions
Quicker access to payments for healthcare professionals. Choose between ACH/direct deposit or virtual card payments. Learn more or find helpful resources today.

Courtesy Review Authorization Form - Claim Appeal - UnitedHealthcare Commercial Plans
Member authorization form for a designated representative to appeal a determination. For use with claim appeal process when unable to access online tools. 

UnitedHealthcare West Capitation, Settlement, Shared Risk Claims, Eligibility, and Patient Management Reports
Access a variety of capitation, claim, quality and profile reports along with provider rosters with the UnitedHealthcare West Reports app.

Hospital Performance-Based Compensation Program
This program provides an incentive to hospitals for quality and efficiency improvements in the delivery of health care affecting the overall health of UnitedHealthcare Commercial members and cost of health care.

Digital solutions for Revenue Cycle Management companies and business vendors
Information to help revenue cycle management companies also referred to occasionally as billing companies, work with UnitedHealthcare. 

Overpayments - Chapter 10, 2022 UnitedHealthcare Administrative Guide
If we inform you of an overpaid claim that you do not dispute, send us the refund check or recoupment request within 30 calendar days (or as required by law or your participation agreement), from the date of identification.

UnitedHealthcare Capitation, Claim, Quality, Roster and Profile Reports
Access a variety of capitation, claim, quality and profile reports along with provider rosters with the UnitedHealthcare Reports app.

UnitedHealthcare West Plan Codes Report
Find more information about UnitedHealthcare’s West Plan Codes Report and NICE system. The plan codes support billing, claims payments, and more. 

CAHPS and the Health Outcomes Survey
The Consumer Assessment of Healthcare Providers and Systems (CAHPS®) survey and the Health Outcomes Survey (HOS) help provide feedback on your patient’s experience with you, the provider and us. UnitedHealthcare’s goal is to continue to help improve the overall experience for your patients and our members. 

View Outpatient Procedure Grouper (OPG) Exhibits 
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.

Waiver of Liability Form for UnitedHealthcare Medicare Advantage
A non-contract provider, on his or her own behalf, may request a reconsideration for a denied claim only if the non-contract provider completes a Waiver of Liability (WOL) statement, which provides that the non-contract provider will not bill the enrollee regardless of the outcome of the appeal.

UnitedHealthcare West Misdirected Claim Returns to the Health Plan Coversheets
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.