How to Make a Medical Billing Claim to UnitedHealthcare

UnitedHealthcare is the single largest health carrier in the United States with well over 40 affiliates and strategical alliances, including All Savers, Midwest Security, Neighborhood Health Partnership, OneNet PPO, OptumHealth, Oxford Health Plans, and UMR.

Here is the general information to help navigate the UnitedHealthcare medical billing process.

1

Submitting a Claim

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There are three simple ways to submit a claim to UnitedHealthcare:

Electronic claims can be submitted through UnitedHealthcare's secure provider website.
Paper claims can be submitted to the UnitedHealthcare claims mailing address listed on the member's ID card.
Electronic claims can be submitted through an electronic vendor/clearinghouse.

A secondary claim is one in which a secondary provider is responsible for making a payment on behalf of the primary payer. There are several ways to submit a secondary claim:

Electronic claims can be submitted as above.
Paper claims can be submitted with the primary payer's Explanation of Benefits (EOB).

When submitting a secondary claim, always be sure to include the adjustment amounts, both at the claim level and service line level. Also include the adjustment reasons (such as contractual obligation, deductible, or coinsurance), and use the codes furnished by the primary payer's remittance.

Finally, include the primary payer paid amount, again at the claim level and service line level.

2

Checking Eligibility, Benefits, and Claim Status

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Prior to rendering services, you can verify the member's eligibility, benefits, and claim status online in three ways:

Use UnitedHealthcare's toll-free voice portal at (877) 842-3210. Say or enter your tax ID number and follow the prompts.
Use UnitedHealthcare's secure provider website.
Use an electronic vendor/clearinghouse.

3

Correcting a Paid Claim

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When making changes to previously paid claims, submit the corrected claims electronically. To so do, enter "CORRECTED CLAIM" in the notes field. Follow up by updating the claim frequency code with either:

7 = Replacement of a Prior Claim
8 = Void/Cancel a Prior Claim

4

Submitting a Prior Authorization Request

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Always submit a prior authorization request at least two business days prior to rendering services. You can do this telephonically or electronically, as follows:

Non-urgent requests should be sent by fax to (800) 303-9902.
Hospital requests should be sent by fax to (800) 699-4712.
General provider requests can be made by calling (877) 842-3210.
Electronic requests can be made through UnitedHealthcare's Prior Authorization and Notification app. Access the tab marked "Submit a Request for Prior Authorization and Notification."
You can also submit a request through an electronic data interchange (EDI).

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The quickest way to appeal a claim is to submit a Claim Reconsideration Request online.

If written documentation is needed, such as proof of timely filing or medical notes, you must fill out and submit the Claim Reconsideration Request Form. The form should be mailed to the claim address on the back of the member’s ID card.

If you are requesting reconsideration of a claim that was denied pending medical documentation, complete the above-listed form and provide both a description of the documentation being submitted along with any pertinent information.

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To request a refund due to an overpayment, you must submit a corrected claim to UnitedHealthcare. 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 UnitedHealthcare and include all necessary information that corresponds to the payment received.

If you have any questions, you can call Provider Services at (800) 445-1638.

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By Phone:

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

By Mail:

Use the address on the back of the member's ID card
Use the address listed in the provider agreement

Business hours are from 6:30 a.m. to 12:00 a.m. EST Monday through Friday, from 7:00 a.m. to 6:00 p.m. EST on Saturday, and from 7:00 a.m. to 5:00 p.m. EST on Sunday.