Appeal and overpayment letters going paperless June 2
Effective June 2, 2023, we will no longer print and mail appeal decision and overpayment letters for most1 UnitedHealthcare Community Plan (Medicaid) health plans. Instead, network medical health care professionals and facilities in Washington will be able to view these letters digitally 24/7 through either the UnitedHealthcare Provider Portal or an Application Programming Interface (API) system-to-system data feed.
Note: Letters will continue to be mailed to Behavioral Health professionals and facilities, and for Home and Community Based Services.
Please share these changes and new digital workflow options with those who are affected, including outside vendors such as revenue cycle management companies.
Options to view overpayment and appeal decision letters
Document Library in the UnitedHealthcare Provider Portal
You can access letters, PRAs and other items for up to 24 months in this secure repository. When new letters are available in Document Library, an email notification is sent to the address on file, which is typically your organization’s Primary Access Administrator.
To access Document Library:
From any page on UHCprovider.com > Sign In > Sign in with your One Healthcare ID and password
In the portal menu, select Documents & Reporting > Document Library. Then select one of the following folders:
Overpayment Documents – Use Advanced Search and search by Check ID or Claim No.
Appeals and Disputes – Use Advanced Search and search by Member Name, Member ID or Case ID
Use Advanced Search to search documents for any 90-day period up to 2 years
Need to change who receives the email notifications? The Profile & Settings Interactive Guide outlines how to update notification preferences. Document Library notifications are limited to 1 email address per letter type. If multiple staff members require notification, consider using a group email address.
Application Programming Interface (API)
API is a fully electronic digital solution that allows you to automate administrative transactions. This option is best for organizations that have the technical resources to program API or the ability to outsource implementation.
To get started, go to API Marketplace and sign in to the marketplace with your One Healthcare ID and password.
On the Welcome screen, click the Start Registration Request button
Select your organization type and click Register
Enter the TIN, click Next, then follow the prompts for registration to schedule a meeting with an API Consultant
Please allow 2 business days for an API Consultant to contact you
Direct Connect to view overpayment letters You can also enroll in this free tool, available in the portal, to review and resolve overpaid claims quickly and easily. Using Direct Connect reduces letters and calls from UnitedHealthcare and additional 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 firstname.lastname@example.org. Please include the requestor’s name, as well as the organization’s TIN, physical address and mailing address.
1 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.