Hawaii and Wisconsin Medicaid will see changes starting Nov. 4
Beginning Nov. 4, we’ll no longer mail overpayment letters sent directly by UnitedHealthcare* for most UnitedHealthcare Community Plans to network health care professionals (primary and ancillary) and facilities in Hawaii and Wisconsin. Instead, you’ll be able to view them digitally 24/7.
Note: Overpayment letters will continue to be mailed to Behavioral Health professionals and facilities and Home and Community Based Services.
Please share the following changes and digital workflow options with those who are affected, including outside vendors such as revenue cycle management companies.
In the menu, select Documents & Reporting > Document Library > Overpayment Documents folder
Use Advanced Search and search by Check ID or Claim No. to help you find what you need
Notifications: When new letters are available in Document Library, an email notification will be sent to the address on file, which is typically the Primary Access Administrator.
Need to notify multiple staff members? Document Library notifications are limited to 1 email address per letter type. If multiple staff members require notification, the Primary Access Administrator can consider using a group email address. See our Paperless Delivery Options for Primary Access Administrator for more information.
View using API: You should consider API if you have significant claims volume and either automate correspondence intake or prefer an option other than looking up individual items in Document Library. Data can be pulled into your practice management system, portal or any application you prefer. API requires technical programming between your organization and UnitedHealthcare.
You can also view overpayment letters using Direct Connect: This free tool, is available in the UnitedHealthcare Provider Portal. Enrolling in Direct Connect helps you review and resolve overpaid claims quickly and easily. Use Direct Connect to reduce letters and calls from UnitedHealthcare and your work with third-party vendors. Here’s how it works:
All initial overpayment notification letters will post to Document Library
Subsequent communications, including reminder notifications and disagreements with overpayment findings, will be done via Direct Connect. You can also use the tool to submit refunds.
To enroll, email email@example.com. Please include the requestor’s name, as well as the organization’s tax ID number (TIN), physical address and mailing address.
What’s ahead in paperless
Letters we mail you aren’t the only communications going digital. Looking ahead to 2023, contracted health care professionals and facilities will be required to submit most claims, claim attachments, reconsideration requests and appeal requests electronically. We’ll also begin to introduce digital member ID cards for commercial plans. All transitions will be announced in Network News at least 90 days prior to the change. We encourage you to explore our digital solutions and review your workflows so that your team is prepared. Review the most up-to-date information, exclusions and schedule.
* These changes include the following overpayment letters:
Overpayment identified – Notifying you that UnitedHealthcare paid too much on a processed claim
Overpayment reconsideration requests – Acknowledging UnitedHealthcare received your request to review our overpayment determination
Overpayment reconsideration decision – Providing the outcome of the reconsideration review and outlining what happens next
This change includes letters sent by Optum for payment accuracy reviews they perform on behalf of UnitedHealthcare. It does not include overpayment letters sent by any other vendor. Those letters will continue to be mailed. Most will include both the vendor and UnitedHealthcare logos, and explain their review was done on our behalf.