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.
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.
Our Healthcare Professional Education and Training page is your source for on-demand education created specifically for UnitedHealthcare providers. It gives you in-depth information and meaningful updates from UnitedHealthcare 24/7 and can be accessed from any device.
Claims and Payments: Get the most recent claims processing information.
Link Tutorials: UnitedHealthcare Provider Portal Tutorials will quickly get you up to speed with our online self-service tools.
State-Specific Information: Each state has its own page for state-specific information and resources.