UnitedHealthcare Basics for Medical Billers

Claims and Precertification Information for UnitedHealthcare

UnitedHealthcare is the single largest health carrier in the United States. Medical billers are likely to interact with this large corporation. They have many affiliates including All Savers, Midwest Security, Neighborhood Health Partnership, OneNet PPO, OptumHealth, Oxford Health Plans, and UMR. Here is the basic information you need to navigate their services.

1
General Information for UnitedHealthcare

Health Insurance Claim Form
Tetra Images/Getty Images

Contact Numbers

  • United Voice Portal: 1-877-842-3210
  • Benefits and Eligibility: 1-877-842-3210
  • United Healthcare Online Help Desk: 1-866-842-3278, option 1
  • Electronic Data Interchange (EDI)Claims: 1-800-842-1109
  • Electronic Payments and Statements (EPS): 1-877-602-6194
  • Hospital Comparison Program: 1-866-270-5588
  • United Behavioral Health: 1-877-633-7824
  • View360 Patient Opportunity Summary Reports: 1-866-270-5588
  • Practice-Facility Updates: 1-877-842-3210
  • Physician Designation Program: 1-866-270-5588
  • Specialty Center Designation Program: 1-866-270-5588


Address Information
On the back of the member's card and/or listed in the provider agreement

Web Address
www.unitedhealthcareonline.com

2
Eligibility, Benefits and Claim Status

Female pharmacist talking on the telephone
Glow Wellness/Getty Images

Eligibility, benefits and claim status can be verified online in three ways:

  1. United Voice Portal Toll-free Number
  2. Through United Healthcare’s secure provider website, available through www.unitedhealthcareonline.com
  3. Through an electronic vendor/clearinghouse

Business Hours (Eastern Time)

Monday thru Friday: 6:30 a.m. - 12 a.m.
Saturday: 7 a.m. - 6 p.m.
Sunday: 7 a.m. - 5 p.m.

3

Businesswoman sending fax
Jack Hollingsworth/Getty Images

Submit precertification requests at least two business days prior to rendering services by:

  • Non-Urgent precertification requests only fax 800-303-9902
  • Hospital Notification only fax 800-699-4712
  • General Provider Phone Number 877-842-3210
  • Electronic Referral System through www.unitedhealthcareonline.com
  • Submit via EDI

More

4
Billing Information

Businesswoman working on computer
Morsa Images/Getty Images

There are three simple ways to submit claims:

  1. Electronic claims can be submitted through UnitedHealthcare's secure provider website, available through www.unitedhealthcareonline.com.
  2. Electronic claims can be submitted through an electronic vendor/clearinghouse.
  3. Paper claims can be submitted to the UnitedHealthcare claims mailing address listed on the member's ID card.

Secondary claims:

  • Submit electronically
  • Paper claims can be submitted with the primary payer's EOB
  • Include adjustment amounts - at both claim level and service line level (if available)
  • Include adjustment reasons - contractual obligation, deductible, coinsurance, etc. Use the codes furnished by the primary payer's remittance
  • Primary payer paid amount - at both claim level and service line level (if available)

5
Timely Filing Requirements

Woman circling day on wall calendar, close-up
Jeffrey Coolidge/Getty Images

Timely filing limits are specified in the provider agreement.

6
Corrected Claims

Hands on a keyboard
Ghislain & Marie David de Lossy/Getty Images
  • When making changes to previously paid claims, submit corrected claims electronically. Enter "CORRECTED CLAIM" in the notes field. Update the Claim Frequency Code with:
    7 = Replacement of a prior claim
    8 = Void/cancel of a prior claim
  • When making changes to previously denied claims, submit corrected claim on paper with a United Healthcare Claim Reconsideration Form and follow instructions.

7

Opening an envelope
tulcarion/Getty Images

Submit a corrected claim and United Healthcare will recover/recoup the overpayment which will be reported on an ERA with a reversal of the incorrect claim adjudication, followed by the corrected adjudication of the claim.

Refunds due to existing credit balances can be sent to:

UnitedHealth Group Recovery Services
P.O. Box 740804
Atlanta, GA 30374-0804

Overpayments must be submitted within 30 days of receiving a request from United Healthcare and include all necessary information that corresponds with the payment received.

More

8

Businesswoman looking at business card
Tammy Hanratty/Getty Images

The quickest way to submit a Claim Reconsideration request is online. Go to www.unitedhealthcareonline.com

If written documentation is needed, such as proof of timely filing or medical notes, you must use the Claim Reconsideration Request Form found on www.unitedhealthcareonline.com. The form should be mailed to the claim address on the back of the Customer’s health care ID card.

If you are submitting a Claim Reconsideration Request Form for a claim which was denied requesting medical documentation:

  1. Complete the Claim Reconsideration Request Form
  2. Provide a description of the documentation being submitted along with all pertinent documentation.

More

Continue Reading