August 01, 2022

Temporary changes coming for select existing commercial plan claims

Starting Sept. 1, 2022, fully insured Individual and Group Market health plans for existing customers will begin the transition to UnitedHealthcare’s new commercial claims processing system. Transitions will occur monthly over the next year, aligned with the plan’s annual renewal date.

The September transition affects 5 fully insured business products in 9 states:

  • Products: Choice, Choice Plus, Core, Core Essential, Non Diff PPO, Options PPO
  • States: Alabama, Connecticut, Illinois, Minnesota, Montana, North Dakota, New Jersey, Oklahoma and South Dakota
  • Affected membership: Approximately 6,700 members

Here’s what you need to know and how this may impact you.

New member ID cards will be issued and payer ID or contract ID may change

All impacted members will receive new plan ID cards. In some cases, the payer ID or contract ID for claims may change.

  • Impact – To avoid claim denials, please ask for the member ID card at each visit and verify that the information in your systems matches.

Temporary payment change: Virtual card payments (VCP) will not be available
For the impacted states and commercial products noted above, VCP payments will be temporarily suspended for a few months beginning Sept. 1 until system updates are completed.

  • Impact: Affected claim payments will temporarily move to paper checks until first quarter 2023. Because this only affects certain plans, you may receive payments by both VCP and paper checks during the transition. 
    • Health care professionals who currently receive payments via automated clearing house (ACH) are not affected. Those claims will continue to be paid electronically.
    • This transition will not affect the following:
      • Current VCP for Medicare Advantage and Medicaid (Community Plan) claims
      • Commercial claims processed on a different claims processing system
    • If you want to receive fast, secure electronic payments, and avoid any temporary payment changes, please consider signing up for ACH direct deposit
      • We encourage you to enroll by Aug. 15, 2022 to allow sufficient time for registration to be complete before UnitedHealthcare stops mailing paper checks

Paperless claim letters: Not available in Document Library until early 2023
Full integration of claim-related letters and documents within Document Library in the UnitedHealthcare Provider Portal won’t be complete until first quarter 2023.

  • Impact: Beginning Sept. 1, you’ll receive these documents in the mail, even if you’ve been receiving them electronically as part of our paperless initiatives. Once the transition is complete, paper mailings will end, and documents will be available in Document Library. You’ll be notified when that occurs.
    • This does not affect any documents transmitted via EDI or API

Background on new claims platform
In September 2021, UnitedHealthcare launched a phased rollout of an enhanced claim processing system designed to simplify benefits, claims, payments and referral processes. To date, this transition has occurred in certain new health care plans sold in a number of states. The transition of existing customers/health plans to the new platform begins in September 2022 and continues through 2023 as plans renew.

These releases will not impact access to the UnitedHealthcare Provider Portal or your ability to perform tasks such as prior authorizations, claims submittals or benefit determinations. However, you may experience changes or gaps in your user experience on the portal as services transition.

Questions? We’re here to help.
If you have any questions about this transition, please contact your Provider Advocate. You can also call UnitedHealthcare Provider Services at 877-842-3210, TTY/RTT 711, 7 a.m.–5 p.m. CT, Monday–Friday.