Dec. 1: Electronic reconsideration and appeal submissions required

Affects Louisiana and Pennsylvania Medicaid

Starting Dec. 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) members in Louisiana and Pennsylvania. 

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
  • 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 original 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
• You will be guided through the submission process and prompted to upload any supporting documents, review your information and submit
• Use Advanced Filter to search Document Library for your pre-service appeal decision 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
    • 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 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.

Questions? We’re here to help

Connect with us through chat 24/7 in the UnitedHealthcare Provider Portal.

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

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

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