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Claims and payments

We have online tools and resources to help you manage your practice’s claim submissions and payments.

Need to submit a claim, check status or submit a reconsideration request? Use the Claims and Payments tool found within the UnitedHealthcare Provider Portal.  For more information, visit our Claims, billing and payments page.

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If you aren’t satisfied with the outcome of a claim reconsideration request, you may submit a formal claim dispute/appeal using the process outlined in your Care 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’ll contact you if we believe it will take longer than 30 days to render a decision.
  • Additional state requirements may apply. Please consult your state’s Care Provider Manual for more details

 

Please allow 10 business days from the submission date before requesting a status update to enable us to begin processing the review.

The UnitedHealthcare Community Plan of Ohio is making this information available to participating care providers to help you better understand when we make adjustments or corrections to care provider payments.


2025 Claims Payment Systemic Error Reports

 

2024 Claims Payment Systemic Error Reports

 

2023 Claims Payment Systemic Error Reports

To view current claim reconsideration information, sign in to the UnitedHealthcare Provider Portal.

There are 2 options available for care providers who are enrolled to receive electronic payments from UnitedHealthcare — Automated Clearing House (ACH)/direct deposit and virtual card payment (VCP). Both options are facilitated by Optum Pay, a full-service payment and remittance solution. You can learn more about these options on our Electronic payment options page.

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 get started with electronic transactions.

 

Learn more about EDI

 

Next Generation program launches new Electronic Data Interchange and fiscal intermediary

Please note that the new Electronic Data Interchange (EDI) and fiscal intermediary, effective Feb. 1, 2023, only apply to UnitedHealthcare Community Plan of Ohio (Medicaid) plans. It does not apply to Dual-Eligible Special Needs Plans (D-SNP) or Medicare-Medicaid (MMP) plans.

 

In addition, when submitting claims to the fiscal intermediary, please submit with the MMIS ID, not the UnitedHealthcare ID.

 

A PRA is generated for every processed claim and includes relevant details about how the claim was processed. You can access them a variety of ways, including Document Library, Electronic Data Interchange (EDI) or Application Programming Interface (API). Learn more in our PRA Overview.