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 startedopen_in_new 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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