AZ, MO, D.C.: Get ready for paperless Medicaid prior authorization and clinical decision letters
Beginning Sept. 9, 2022, we will no longer print and mail prior authorization and clinical decision letters for most*UnitedHealthcare Community Plans to network health care professionals and facilities in Arizona, Missouri and Washington, D.C. Instead, you’ll be able to view them 24/7 through either the UnitedHealthcare Provider Portal or an Application Programming Interface (API) system-to-system data feed.
Please share these changes and new digital workflow options with those who are affected, including outside vendors, such as revenue cycle management companies.
Letter types going paperless
Pre-service/prior authorization decision letters
Inpatient review letters, including concurrent, retrospective, length of stay and level of care
Peer-to-peer decision letters
Extension for lack of clinical information letters
Complex care management and OrthoNet letters available in Document Library
How to view prior authorization and clinical decision letters digitally
Then, click Document Library and select the Prior Auth Letters folder
Use Advanced Search and search by Member Name, Member ID or Notification ID 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 Paperless Delivery Options for Primary Access Administrators 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.
Note: If you have access to the Prior Authorization and Notification tool in the portal, you also have direct access to the Prior Auth Letters folder in Document Library. If you don’t have access to the tool and need to view letters in Document Library, please request access from your Primary Access Administrator.
TrackIt: Found on the portal home page, TrackIt notifies you of prior authorization requests, claims, reconsiderations and appeals that need attention. It also provides a direct link to view prior authorization decision letters quickly. If you use tools on our secure portal for prior authorizations, you’ll already have access to those items in TrackIt.
Note: You cannot start or submit prior authorizations using TrackIt.
What’s ahead in paperless Letters we mail you aren’t the only communications going digital. Later this year, we’ll begin to introduce digital member ID cards and the ability to submit claim attachments online through an EDI 275 transaction. And, in 2023, we will start requiring contracted health care professionals to submit most claims, reconsideration requests and appeal requests electronically. All transitions will be announced in Network Newsat least 90 days before mailings end to give you time to prepare for the change. For the most up-to-date information, exclusions and full schedule, go to UHCprovider.com/digital.