Claims and Payments | UnitedHealthcare Community Plan of Kansas

If you are not satisfied with the outcome of a Claim Reconsideration Request, you may submit a formal Claim Dispute/Appeal using the process outlined in your provider manual.

• A formal Claim Dispute/Appeal is a comprehensive review of the disputed claim(s), and may involve a review of additional administrative or medical records by a clinician or other personnel.
• UnitedHealthcare Community Plan generally completes the review within 30 calendar days. However, depending on the nature of the review, a decision may take up to 60 days from the receipt of the claim dispute documentation. We will contact you if we believe it will take longer than 30 days to render a decision.
• Please allow 10 business days from the submission date to enable us to begin processing the review before requesting a status update.

Additional state requirements may apply. Please consult your state Care Provider Administrative Guide or Manual for more details or contact the provider services center.

Additional information about the Appeals, Grievances and State Fair Hearings process for Kansas can be found in the Care Provider Administrative Manual. 

Forms

• Community Plan of Kansas KanCare External Independent Third Party Review Request Form
  
• Non-Participating Care Providers: Prior Authorization Required for All Services
• Non Participation Reimbursement Agreement
• Provider Appeal Processes

To view up to date claim reconsideration information go to UHCprovider.com/claims.

Using Electronic Data Interchange (EDI) for all eligible UnitedHealthcare transactions can help your organization improve efficiency, reduce costs and increase cash flow. We encourage you to use the following tools and resources to help you get started with electronic transactions.

Care providers who wish to refund an overpayment on any UnitedHealthcare Community Plan account for the KanCare program can submit a check to the following address:

UnitedHealthcare
P.O. Box 5230
Kingston, NY 12401

Please also include the following information with your check so the refund is accurately credited to our system in a timely manner:

• Patient name
• Patient Medicaid ID #
• Date of service
• Amount originally paid by UnitedHealthcare
• Amount overpaid
• Reason account is considered overpaid
• Claim number and type (if available)
• Unique ID number, also known as the reference number from recovery letter (if available)
• Copy of UnitedHealthcare remit (if available)
• Name and phone number of person submitting refund in case we have questions

If you have questions, please call Provider Services at 877-542-9235.

All vision claims should be submitted to March Vision, the UnitedHealthcare Community Plan of Kansas vision vendor:

MARCH Vision Care Claims
6701 Center Drive West, Suite 790
Los Angeles, CA 90045 

A PRA is generated for every processed claim and includes relevant details about how the claim was processed.