Digital solutions for Revenue Cycle Management companies and business vendors

We know that Revenue Cycle Management companies (RCMs), billing services and business vendors perform many types of work on behalf of health care professionals. Our goal is to make it easier for you to work with us, reduce the time it takes for you to perform claim and clinical activities and, ultimately, help you get paid faster.

To do this, we offer 3 digital solutions to help to fit your needs: Application Programming Interface (API), Electronic Data Interchange (EDI) and the UnitedHealthcare Provider Portal.

How to get started

Review the Digital Solutions for Revenue Cycle Management Companies guide for a quick overview of each solution.

Application Programming Interface (API)

Electronic Data Interchange (EDI)

  • An electronic method for exchanging data in a Health Insurance Portability and Accountability Act (HIPAA) standard, secure format through a clearinghouse
  • For more information, check out UHCprovider.com/edi > EDI Contacts

UnitedHealthcare Provider Portal

Digital solution benefits and capabilities 

  • Quickly check UnitedHealthcare member eligibility 
  • Find the member’s cost share, deductible or out-of-pocket responsibility
  • Determine network and tier status
  • View claims information for multiple UnitedHealthcare plans
  • Access letters, remittance advice documents and reimbursement policies
  • Access claim, prior authorization letters and provider remittance advice for most Medicare and commercial members, including UnitedHealthcare West. View letters and take action before letters arrive in the mail.
  • Check the status of your notification and prior authorization requests – including those made by phone
  • Check the status of a referral request 

Proven results that’ll save on time and cost

The Council for Affordable Quality Healthcare (CAQH), a nonprofit alliance, is the leader in creating shared initiatives to streamline the business of health care. The 2020 Council for Affordable Quality Healthcare (CAQH) Index shows that the average cost to conduct transactions manually is consistently higher than the cost of electronic transactions for health care professionals and health plans.1

Please note: Use and compatibility of digital solutions and resources may be subject to certain limitations or requirements. Please review all relevant materials for details. Please also review your participation agreement for any obligations and rights regarding electronic connectivity and transactions.

1 2020 CAQH INDEX® Closing the Gap: The Industry Continues to Improve, But Opportunities for Automation Remain. caqh.org/sites/default/files/explorations/index/2020-caqh-index.pdf.