Peoples Health is moving to UnitedHealthcare systems

Starting Jan. 1, 2024, Peoples Health network providers will use UnitedHealthcare tools and processes for most tasks, including claim submissions, EFT payments, prior authorization requests and appeal requests for Peoples Health patients.

Claim submissions

• For claims with dates of service before Jan. 1, continue to submit claims to Peoples Health as you do today
• For claims with dates of service on or after Jan. 1, submit claims to UnitedHealthcare electronically using payer ID 87726 through the UnitedHealthcare Provider Portal

If you have a question about a claim with a 2023 date of service, reach out to your Peoples Health representative. If the claim is for a patient who was enrolled in a UnitedHealthcare Medicare Advantage plan in the state of Louisiana, continue to use the UnitedHealthcare standard service model.

Claim payments

You have the following 2 options to receive payments from UnitedHealthcare for 2024 dates of service:

• Automated Clearing House (ACH)/Direct deposit: This option is preferred by most practices for its speed and efficiency in depositing claim payments directly into your bank account(s). Each payment is issued for the full amount of the claim payment, and there is no charge for the deposit.
• Virtual card payment (VCP): This option processes as a credit transaction through the same terminal used for patient copays. Each payment is issued for the full amount of the claim payment. However, virtual card transactions are subject to additional terms and conditions, including fees, between you and your card service processor.

Learn more about each option and access the EFT enrollment guide.

If you already have an EFT payment method set up with UnitedHealthcare for non-Peoples Health patients, that EFT payment method will be used for paying your Peoples Health claims with 2024 dates of service.

Claim appeals

For claim reconsideration requests, appeals or disputes for dates of service before Jan. 1, Peoples Health will process the appeals. Continue to use existing Peoples Health processes and contact information for submitting the reconsiderations and appeals, as you have in the past.

For claim reconsideration requests, appeals or disputes for dates of service on or after Jan. 1, UnitedHealthcare will process the appeals. You must use UnitedHealthcare processes and contact information for submitting the appeals. For more information, review this online training presentation.

Prior authorizations

On Jan. 1, you’ll begin submitting prior authorization requests through the UnitedHealthcare Provider Portal:

• Go to UHCprovider.com and click Sign In at the top-right corner
• Enter your One Healthcare ID and password
  • New users who don’t have a One Healthcare ID: Visit UHCprovider.com/access to get started
• In the menu, select Prior Authorizations 
• Scroll down to “Create a new notification or prior authorization request” and click Create New Submissions
• Enter the required information and submit

If we don’t receive a prior authorization request before the date of service, we’ll deny the claim and you won’t be permitted to balance bill members for the service.

Resources

• Prior Authorization and Notification: Interactive User Guide
• Prior Authorization and Notification webpage
• Claims submission guide for submitting online
• Peoples Health transition FAQ

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