Last modified: Jan. 18, 2023.
Updates: Article now includes additional benefits to digital submissions, reconsideration and appeals-specific training guide, updated instructions for accessing API Marketplace and Medicare Supplement plan exclusion.
In 2023, our work to replace paper with digital tools will shift to eliminating paper you send to us. This change:
As a result, beginning Feb. 1, 2023, you’ll be required to submit claim reconsiderations and post-service appeals electronically. This change affects most* network health care professionals (primary and ancillary) and facilities that provide services to commercial and UnitedHealthcare® Medicare Advantage plan members. This does not affect pre-service clinical appeals.
Please share the following changes and digital workflow options with your team, including outside vendors, such as revenue cycle management companies.
To get started:
Please allow 2 business days for our API Consultants team to contact you.
Note: Attachments cannot be sent for other types of claim submissions.
Reminder: Submission requirements
There is a 2-step process for network health care professionals and facilities if they don’t agree with the outcome of the original claim payment or denial. (Claim reconsiderations don’t apply to some states based on applicable state law.)
Step 1 is to file a claim reconsideration request. Step 2 is to file an appeal if you disagree with the outcome of the claim reconsideration decision. The 2-step process allows for a total of 12 months for timely submission of both steps. More information can be found in the Network Administrative Guide at UHCprovider.com/guides.
In 2023, you can expect more paper submissions and mailings we send you to go digital. Later in 2023, we’ll require you to submit claims and claim attachments electronically. We’ll also continue to encourage UnitedHealthcare commercial members to use digital ID cards.
All required paperless 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 at UHCprovider.com/digital.
Please contact UnitedHealthcare Provider Services at 877-842-3210, TTY/RTT 711, 7 a.m.–5 p.m. CT, Monday–Friday.
For help accessing the portal and technical issues, please contact UnitedHealthcare Web Support at email@example.com or 866-842-3278, option 1, 7 a.m.–9 p.m. CT, Monday–Friday. Primary Access Administrators may also contact Web Support for help updating notification emails.