Beginning Feb. 1, 2023, United Healthcare is requiring network commercial and Medicare Advantage health care professionals and facilities to submit claim considerations and postservice appeals electronically. This mandate does not apply to preservice clinical appeals.
The two electronic submission options include the UnitedHealthcare Provider Portal and the Application Programming Interface (API). Using the API allows for distribution of data to a practice management system or any preferred application. The API option requires technical programming between the organization and UnitedHealthcare. Instructions for this technical programming are available on the UnitedHealthcare website.
If network health care professionals and facilities disagree with an original claim payment or denial, they must follow a two-step process. Step 1 is to file a claim reconsideration request, and step 2 is to file an appeal electronically if there is disagreement with the outcome of the claim reconsideration decision. More information can be found in the Network Administrative Guide at UHCprovider.com/guides.
As stated in the announcement: “Later in 2023, we’ll require you to submit claims and claim attachments electronically. … All required paperless transitions will be announced in Network News at least 90 days prior to the change. We encourage you to explore our digital solutions and review your workflows so that your team is prepared.”
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