Claims and Payments | UnitedHealthcare Community Plan of North Carolina

We have online tools and resources to help you manage your practice’s claim submission and payment.

Need to submit a claim, check status or apply for reconsideration? Go to UHCprovider.com/claims to learn about our Claims (on Link).

In preparation for Managed Care Launch on 07/01/2021, UHC Community Plan of North Carolina will comply with the prompt payment requirements as defined in the PHP contract. Those requirements mandate processing payments within 14 calendar days for pharmacy claims and 30 calendar days for medical claims. 

Please note the following timeline the first check cycles will begin:

  • Vision claims - week of 07/05/2021
  • Pharmacy and Medical claims - 07/12/2021
  • NEMT claims - week of 07/16/2021  

For additional inquiries, please contact Provider Services at 800-638-3302.

If you aren’t satisfied with the outcome of a claim reconsideration request, you may submit a formal claim dispute/appeal using the process outlined in your Care Provider Manual.

  • A formal claim dispute/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.

To view current claim reconsideration information, go to UHCprovider.com/claims.

Direct deposit and VCP information is available to EPS-enrolled care providers in the Electronic Payments & Statements (EPS) tool on Link.

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.

If you are an Out-of-State Provider, you MUST be contracted with NC Medicaid through the NC Tracks system in order for claims to be paid.

A PRA is generated for every processed claim and includes relevant details about how the claim was processed.