Texas Medicaid: Coordination of benefits and prior authorization
Some UnitedHealthcare Community Plan members may have other health insurance, such as commercial or Medicare, as their primary coverage. If they do, Medicaid is the last payer on a claim. When a member has other primary insurance, and that primary insurance requires prior authorization, you won’t have to submit a prior authorization request to UnitedHealthcare Community Plan.
Requesting prior authorization
When UnitedHealthcare Community Plan of Texas members have another insurance as the primary payer, prior authorization should be requested from only the primary insurance. You aren’t required to request prior authorization from UnitedHealthcare Community Plan.
If the member has primary insurance through another UnitedHealthcare plan, you should submit your prior authorization request through the UnitedHealthcare Provider Portal at UHCprovider.com/priorauth.
Submitting a secondary claim to Medicaid
You should first bill the member’s primary insurance. The primary insurance may:
- Pay the full claim for the service
- Pay a portion of the claim
- Submit a claim to UnitedHealthcare Community Plan for payment consideration, include the primary insurance explanation of benefits (EOB)
- Not respond within 110 days from the date of service
- Submit the full claim to UnitedHealthcare Community Plan for payment consideration, include documentation of your primary insurance claim submission
- Deny the claim
- Submit a claim to UnitedHealthcare Community Plan for payment consideration, include the primary insurance EOB showing the denial
You can find more information at UHCprovider.com/claims.
Verifying other health insurance
You can verify a member’s other health insurance or third party liability information in TexMedConnect. Members may be asked to report other coverage.
Questions?
If you have questions, contact your provider advocate or call Customer Service at 888-887-9003, 8 a.m. – 6 p.m. Central Time, Monday – Friday.
