Eligibility and Benefits
Eligibility and benefits information for health care providers. Verify patient eligibility, determine benefits, and find additional available coverage.
UnitedHealthcare Provider Portal tools
Eligibility and benefits
Confirm patient eligibility and find their benefits including plan requirements, preventive care and other care opportunities. Determine if a plan requires prior authorization or notifications or referrals, download digital ID cards and find any additional coverage available.
More benefits tools
Access UnitedHealthcare payer portals, including Surest, UMR, and All Savers Alternate Funding; plus tools for dental, behavioral health and vision, Optum and more.
Resources
Frequently searched
Reconsideration Form
This form is to be completed by physicians, hospitals or other health care professionals for paper Claim Reconsideration Requests for our members.
Eligibility and benefits interactive guide
Interactive guide: Use the UnitedHealthcare Provider Portal to verify member eligibility, determine benefits, view care plans, get a digital copy of member ID cards and more.
UnitedHealthcare Dental Provider Portal
The UnitedHealthcare Dental Provider Portal helps providers get access to more patients, competitive reimbursement rates and dedicated support. Health care professionals can get detailed patient benefit and claims information and access to trainings designed to help you and your practice.
Drug Lists and Pharmacy
Information related to pharmacy coverage decisions based on an understanding of how health plan coverage affects total member health care including drug lists, supply limits, step therapy, and infusion care.
Behavioral Health Resources
These resources can help primary care providers screen patients for depression, Attention Deficit Hyperactivity Disorder (ADHD) and alcohol/substance misuse. As you’re aware, treatment is critical since it can contribute to the patient’s readiness to change at risk behaviors.
Cancer Therapy Pathways Program
The program is intended to improve quality and value in cancer care by supporting the use of therapies supported by evidence-based guidelines to improve outcomes.
Cancer Support Program
This program focuses on supporting cancer patients who are at high risk for complications and side effects associated with their cancer or treatment and would benefit from the support of our experienced, specialized cancer nurses.
Application Programming Interface (API)
Our API solutions allow you to electronically receive detailed data on the status of claims and member eligibility and benefits. Information returned emulates the information on UnitedHealthcare Provider Portal and complements Electronic Data Interchange (EDI) transactions.
Telehealth
UnitedHealthcare believes that telehealth can extend every practice’s reach to meet members where they are. We want to help your practice build your telehealth capabilities and support your telehealth journey. This page outlines the basic steps to prepare a practice to deliver telehealth, offers tips and best practices and suggests tools to measure telehealth’s effectiveness for the practice population.
Maternity Support for UnitedHealthcare Community Plan Members
These resources are especially tuned to skilled nursing facilities, including brochures for patient education, support for billing and reimbursement, and a special focus on Medicare Advantage and the UnitedHealthcare Passport Service.
Individual Health Record™ (IHR)
A digital tool that provides an all-in-one record of an individual’s health, enabling a person and their care team to help improve collaboration and care.
Worksite Wellness Health Screening
Offered to our Commercial market, the program is an employer-sponsored biometrics screening available to employees, spouses and dependents. Participants may receive incentives for completing the screening and achieving certain biometric results.
UnitedHealthcare Insights
Tracking metrics and looking at data to help make informed decisions may take a lot of time. UnitedHealthcare Insights helps you make them more easily with a single, unified tool for reviewing and acting on UnitedHealthcare data, all in one place.