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Online Resources and How to Contact Us - Chapter 1, 2020 UnitedHealthcare Administrative Guide

UHCprovider.com

UHCprovider.com is your home for care provider information with access to Electronic Data Interchange (EDI), Link self-service tools, medical policies, news bulletins, and great resources to support administrative tasks including eligibility, claims, claims status and prior authorizations and notifications

Electronic Data Interchange (EDI)

EDI is a self-service resource using your internal practice management or hospital information system to exchange transactions with us through a clearinghouse.

The benefit of using EDI is it permits care providers to send batch transactions for multiple members and multiple payers in lieu of logging into different payer websites to manually request information. This is why EDI is usually care providers’ first choice for electronic transactions.

  • Send and receive information faster
  • Identify submission errors immediately and avoid processing delays
  • Exchange information with multiple payers
  • Reduce paper, postal costs and mail time
  • Cut administrative expenses
  • EDI transactions available to care providers are:
    • Claims (837),
    • Eligibility and benefits (270/271),
    • Claims status (276/277),
    • Referrals and authorizations (278),
    • Hospital admission notifications (278N), and
    • Electronic remittance advice (ERA/835).

Visit UHCprovider.com/EDI for more information. Learn how to optimize your use of EDI at UHCprovider.com/optimizeEDI.

Getting Started

  • If you have a practice management or hospital information system, contact your software vendor for instructions on how to use EDI in your system.
  • Contact clearinghouses to review which electronic transactions can interact with your software system.

Read our Clearinghouse Options for more information.

Link

Link provides online resources to support your administrative tasks including eligibility, claims and prior authorization and notifications.

To sign in to Link, go to UHCprovider.com and click on the Link button in the upper right corner. For more information about all Link tools, go to UHCprovider.com/Link.

You will conduct business with us electronically. Using electronic transactions is fast, efficient, and supports a paperless work environment. Use both EDI and Link for maximum efficiency in conducting business electronically.

You can use Link to access information for:

  • UnitedHealthcare Commercial
  • UnitedHealthcare Medicare Advantage
  • UnitedHealthcare Community Plan (as contracted by state)
  • UnitedHealthcare West
  • UnitedHealthcare of the River Valley
  • UnitedHealthcare Oxford Commercial

Available benefit plan information varies for each of our Link tools.

Here are the most frequently used tools:

  • eligibilityLink — View patient eligibility and benefits information for most benefit plans. For more information, go to UHCprovider.com/eligibilityLink.
  • claimsLink — Get claims information for many UnitedHealthcare plans, including access letters, remittance advice documents and reimbursement policies. For more information, go to UHCprovider.com/claimsLink.
  • Prior Authorization and Notification — Submit notification and prior authorization requests. For more information, go to UHCprovider.com/paan.
  • Specialty Pharmacy Transactions — Submit notification and prior authorization requests for certain medical injectable specialty drugs using the Specialty Pharmacy Transaction tile on your Link dashboard.
  • My Practice Profile — View and update* your provider demographic data that UnitedHealthcare members see for your practice. For more information, go to UHCprovider.com/mypracticeprofile.
  • Document Vault — Access reports and claim letters for viewing, printing, or download. For more information, go to UHCprovider.com/documentvault.
  • Paperless Delivery Options — The Paperless Delivery Options tool can send daily or weekly email notifications to alert you to new letters when we add them to your Document Vault. With our delivery options, you decide when and where the emails are sent for each type of letter. This is available to Link Password Owners only.
  • UHC On Air — Watch live broadcasts and on-demand programs on topics important to you. Find instructions for adding UHC On Air to your Link dashboard at UHCprovider.com/uhconair

You need an Optum ID to access Link and use tools available to you. To register for an Optum ID, go to UHCprovider.com/newuser.

Watch for the most current information on our self-service resources by email, in the Network Bulletin, or online at UHCprovider.com/EDI or UHCprovider.com/Link.

* For more instructions, visit UHCprovider.com/Training.

For instructions on joining the UnitedHealthcare provider network, go to UHCprovider.com/join. There you will find guidance on our credentialing process, how to sign up for self-service tools and other helpful information.

UHCprovider.com, or UHCprovider.com/Link

Resources

  • Access to care provider policies and protocols, tools, training and network bulletins.
  • Enroll in Electronic Payments and Statements (EPS) for direct deposit for covered services and electronic remittance advice.
  • Authorizations and referrals information, submissions and status.
  • Verify eligibility and benefits.
  • Verify your network and tier status for a member’s benefit plan.
  • Claims management including filing, status information and claims reconsiderations. 

Help Desks

  • 866-842-3278 (option 1 for UHCprovider.com and Link assistance). 
  • Assistance is available Monday-Friday from 7 a.m. to 9 p.m., Central Time (CT).

EDI: See EDI transactions and code sets on UHCprovider.com/edi

Online: UHCprovider.com/paan

Phone: 877-842-3210 (United Voice Portal)

See member’s health care ID card for specific service contact information.

Medicare Advantage – follow the directions in the customer decision letter

For: Commercial members, All Savers, Golden Rule Insurance Company and UnitedHealthcare Oxford Navigate Individual

An expedited appeal may be available if the time needed to complete a standard appeal could seriously jeopardize the member’s life, health or ability to regain maximum function.

  • Urgent Medical Fax: 801-994-1083
  • Urgent Pharmacy Fax: 801-994-1058
  • Urgent Appeal Fax: 866-654-6323

Notification/Prior Authorization – Submission & Status

Online: UHCprovider.com/priorauth and select the specialty you need.

Phone: 866-889-8054

(Contracted with OptumHealth Physical Health, a UnitedHealth Group company)

Online: myoptumhealthphysicalhealth.com

Phone: 800-873-4575

EDI: UHCprovider.com/edi. View our Claims Payer List to determine the correct Payer ID.

Link: Use Claim Submission for filing and claimsLink for status information and to request reconsiderations.

Online: UHCprovider.com/claims (policies, instructions and tips)

Phone: 877-842-3210 (follow the prompts for status information)

Online: UHCprovider.com/edi

Help: UHCprovider.com/EDI > Contacts

Phone: 800-842-1109 (M-F, 7 a.m. – 9 p.m. CT)
 

UnitedHealthcare EDI Support

Online: EDI Transaction Support Form

Email: supportedi@uhc.com

Phone: 800-842-1109
 

UnitedHealthcare Community Plan EDI Support Online:

EDI Transaction Support Form

Email: ac_edi_ops@uhc.com

Phone: 800-210-8315

Online:

Help Desk: 877-620-6194

Report potential fraud, waste or abuse concerns.

Online: uhc.com/fraud, select the “Report A Concern” icon.

Phone: 844-359-7736

Phone: 877-842-3210 (United Voice Portal)

For more information on fraud, waste, and abuse prevention efforts, refer to Chapter 16: Fraud, Waste and Abuse.

Online: UHCprovider.com/priorauth and select the specialty you need.

Phone: 800-377-8809

Online: myuhc.com

Phone: 877-842-3210

See the member’s health care ID card for carrier information and contact numbers.

Online: professionals.optumrx.com

Phone: 800-711-4555

For participating hospitals, health care, and ancillary providers; Locate your physician or hospital advocate

Online: uhc.com/contact-us/for-providers

You can determine if a member’s benefit plan requires a referral when you view their eligibility profile.

EDI: 278 transaction

Link: UHCprovider.com/referralLink

Online: UHCprovider.com/referrals

Note: Submitted referrals are effective immediately, but may not be viewable for 48 hours.

Online: UHCprovider.com/skillednursing

Phone: 877-842-3210 (for Provider Service)

See the member’s health care ID card for carrier information and contact numbers.

See the member’s health care ID card for carrier information and contact numbers.