The Provider Claim Review tool is moving to the portal

Last modified: August 25, 2021

RightFax will be replaced over the next few months

You will no longer receive or make edits to corrected pseudo CMS 1500 claim forms by fax. You will be able to make updates electronically using the Provider Claim Review (PCR) tool in the UnitedHealthcare Provider Portal.

Optum conducts risk adjustment chart reviews and quality assessments on behalf of UnitedHealthcare Community Plan. To improve this process, Optum is transitioning from RightFax™ to the Provider Claim Review (PCR) tool over the next few months. Until the transition from RightFax is complete, claims will be reviewed using data received from either fax or the PCR tool.

The Provider Claim Review tool streamlines the transfer of diagnosis information (captured in the member’s medical record) by using a corrected pseudo CMS 1500 claim form to include unreported diagnosis codes.

The tool also helps improve the accuracy of health status data so providers can review and approve results before they’re added to the claim record for risk adjustment, which can also lead to better care management.

Enhancing your experience

The Provider Claim Review tool comes with new features to help:

• Make the data more visual and easier to understand
• Complete multiple transactions at once with integrated applications
• Reduce administrative costs and standardize the use of electronic transactions
• Reduce time between receipt of data and claim review, allowing for a more streamlined workflow
• Reduce paperwork, faxes and the need to call

PCA-1-21-02788-Optum-News_08172021