As a care provider, if you are not satisfied with the outcome of a claim reconsideration request, you may submit a formal claim appeal. This process is outlined in your Care Provider Manual.
A Care Provider Claim Formal Appeal can be submitted to:
UnitedHealthcare Community Plan of Indiana P.O. Box 31364
Salt Lake City, UT 84131-0364
The formal clam appeal filing timeframe is 60 calendar days from the reconsideration decision date.
A formal claim appeal is a comprehensive review of the disputed claim(s), and may involve a review of additional administrative or medical records by a clinician or other personnel.
UnitedHealthcare Community Plan generally completes the review within 30 calendar days. However, depending on the nature of the review, a decision may take up to 60 days from the receipt of the claim dispute documentation. We’ll contact you if we believe it will take longer than 30 days to render a decision.
Additional state requirements may apply. Please consult your state’s Care Provider Manual for more details.
Please allow 10 business days from the submission date before requesting a status update to enable us to begin processing the review.
Submit claims using the 1500 Claim Form (v 02/12) or UB-04 form, whichever is appropriate. For Dental claims use the ADA (American Dental Association) claim from. Use applicable coding, including ICD diagnosis code(s), CPT, Revenue and HCPCS coding. Include all necessary data to process a complete claim.
Using Electronic Data Interchange (EDI) for all eligible UnitedHealthcare transactions can help your organization improve efficiency, reduce costs and increase cash flow. We encourage you to use the following tools and resources to get started with electronic transactions.