Feb. 1: Reconsideration and appeal submissions going digital-only

Beginning Feb. 1, 2024, you’ll be required to submit claim reconsiderations and medical pre- and post-service appeals electronically. This change affects most* network health care professionals (primary and ancillary) and facilities that provide services to UnitedHealthcare Community Plan (Medicaid) plan members in the following states: 

If you use an outside vendor, such as a revenue cycle management company, please ensure they’re aware of the following changes and digital workflow options.

How to submit a pre-service appeal

Use the Prior Authorization and Notification tool through the UnitedHealthcare Provider Portal:

• From any page on UHCprovider.com, select Sign In at the top-right corner
• Enter your One Healthcare ID and password
  • New users who don’t have a One Healthcare ID: Visit UHCprovider.com/access to get started
• In the menu, select Prior Authorizations
• Scroll down to “View Status of existing submissions, drafts and make updates” and click “Search Existing Submissions & Drafts”
• Find your service reference number (SRN) and expand to see the details
  • If the details show the coverage status as “Not Covered/Not Approved,” you’ll see the “File a Pre-Service Appeal or a Grievance” link
  • You can also click on the SRN to see the originally entered case details, as well as the “File a Pre-Service Appeal or a Grievance” link under the coverage status section
• Once you click the link, a new tab will open that takes you to the instructions page of the submission form
• You will be guided to complete the form, upload any supporting documents, review your information and submit
• Use Advanced Filter to search Document Library for your pre-service appeal letters

How to submit claim reconsiderations, post-service appeals

Use one of the following options:

1. UnitedHealthcare Provider Portal:

• From any page on UHCprovider.com > Sign In
  • Enter your One Healthcare ID and password
    • Users who don’t have a One Healthcare ID: Visit UHCprovider.com/access to get started
  • In the menu, click Claims & Payments > Look up a Claim to search by the claim number and click Act on Claim

2. Application Programming Interface (API): API is a fully electronic digital solution that allows you to automate administrative transactions. This is a great alternative to Document Library for organizations with medium-to-high claim volume that have the technical resources to program API or the ability to outsource implementation.
   

Get started with API.

For help accessing the portal, technical issues and changing notification preferences, please contact UnitedHealthcare Web Support at 866-842-3278, option 1, 7 a.m.–9 p.m. CT, Monday–Friday. 

You can also contact UnitedHealthcare Provider Services at 877-842-3210, TTY/RTT 711, 7 a.m.–5 p.m. CT, Monday–Friday. 

* Exclusions: Behavioral health professionals and facilities and home- and community-based services.

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