Updated: New commercial claims processing system

Latest incremental release of new claims processing system

In September 2021, UnitedHealthcare began a phased rollout of a new commercial claims processing system. The second phase of that rollout was deployed in November. These are the first steps in our multiyear journey to simplify claim processes. 

Who will be impacted?

The November release affects only new business (on or after Nov. 1, 2021) for the following level-funded plans:

  • Charter
  • Navigate
  • Select
  • Select Plus
  • Freedom
  • Metro (includes Choice, Choice Plus, Core and Liberty plans)

Plans affected by this release are in Alabama, Arkansas, Arizona, California, Colorado, Delaware, Florida, Idaho, Indiana, Massachusetts, Maryland, Maine, Minnesota, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Dakota, Oregon, Pennsylvania, South Dakota, Texas, Utah, Virginia, Washington, West Virginia and Wyoming.

Additionally, the November release will affect the following fully insured new business products in Illinois and Washington:

  • Choice
  • Choice Plus, Core
  • Core Essential
  • Options PPO

Unlike the September rollout, this release does include plans design types that require hospital tiering.

Details: Previous release

The rollout begins with an initial September release that involved select fully insured and level-funded new business benefit plans in the following states: Alabama, Connecticut, Minnesota, Montana, New Jersey, North Dakota, Oklahoma and South Dakota. Additionally, an Oct. 1 release affected fully insured new and existing business products in New Hampshire’s Tufts Health Freedom Plan.

What you need to know: User experience gaps

During these releases, some of you will see changes in your current experience with UnitedHealthcare. These changes (or gaps) will be intermittent and occur during the transition between the existing claims processing system to the new one. We’ve assessed the potential effect of these temporary issues and want to make you aware of 2 of the most visible service changes. These include:

Benefits panel. While member benefit information will remain available during the transition, you may occasionally see it presented in an older format while looking up benefits in the Provider Portal for a new UnitedHealthcare member (effective Sept. 1, 2021, or later). Behind the scenes, our technology teams are building a new online benefits panel that will be quicker and easier to navigate. We expect that you’ll have full access to that service improvement by January 2022.

Rehabilitation and therapy coverage panel. During the transition, you’ll be able to look up cardiac rehabilitation, chiropractic treatment, occupational, physical and speech therapy coverage benefits for all existing UnitedHealthcare members. However, there will be occasions during which this coverage information for new UnitedHealthcare members (effective Sept. 1, 2021, or later) will not be available in the Provider Portal. You can access this benefit coverage information by viewing the back of your member’s UnitedHealthcare insurance card, which has information on how to contact our provider team. By second quarter 2022, you can expect the return of a fully searchable online resource for these rehabilitation, chiropractic and therapy services.

Questions?

If you have questions, please contact your UnitedHealthcare network representative.