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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. Our self-service resources for claims include using Electronic Data Interchange (EDI) and the claimsLink tool in Link.

Direct deposit and virtual card payments (VCP) information is available on Link in the Electronic Payments & Statements tool, 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.

With the Claim Submission Tool you can:

  • Submit professional claims, including National Drug Code (NDC) claims, for all UnitedHealthcare members
  • Easily see which fields are required. The highlighted fields will update based on the information you enter
  • View on-screen messages that allow you to correct certain errors before you hit submit
  • Eliminate paper, postage and mail time

 To learn about claim submission methods and connections using Electronic Data Interchange (EDI), visit the EDI 837: Electronic Claims page for more information.

With claimsLink, you can:

  • View claims information for multiple UnitedHealthcare® plans
  • Access letters, remittance advice documents and reimbursement policies
  • Submit additional information requested on pended claims
  • Flag claims for future viewing
  • Submit corrected claims or claim reconsideration requests
  • Receive instant printable confirmation for your submissions

Helpful Resources to Learn More

To check the status of claims using Electronic Data Interchange (EDI), visit the EDI 276/277 Claims Status page. Learn more about Enhancements to Claim Status EDI Transactions (276/277).

You can use the claimsLink tool 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 tool 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 tool. 

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 tool 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.

The Claim Research Project tool 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 tool 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 tool 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 tools on Link.

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

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) tool 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 more information on using the ERA/835 EDI transaction to auto-post claim payments or for tips on how to work with 835 files, visit the EDI 835: Electronic Remittance Advice (ERA) page.

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

The UnitedHealthcare West Electronic Funds Transfer (EFT) Enrollment tool 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 tool.

UnitedHealthcare West EFT Enrollment Tool Overview

With the UnitedHealthcare West EFT Enrollment tool, 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 Tool?

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 tools for different health plans. Use the UnitedHealthcare West EFT tool for Signature Value and Medicare Advantage plans only. See page 2 of the EPS Flyer to learn which plans participate with EPS.

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.)

If you are new to the Fee Schedule Lookup, use the Fee Schedule Lookup Quick Reference to get started.

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 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) tool 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 tool or to see more information about EPS.

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

The Electronic Payments & Statements (EPS) tool 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 tool or to see more information about EPS.

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

The Electronic Payments & Statements (EPS) tool 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 tool or to see more information about EPS.

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

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

The Electronic Payments & Statements (EPS) tool 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 Tool.