Quick reference guide 2021 Administrative Guide

Expand All add_circle_outline

If you are interested in joining our network, visit UHCprovider.com/join. To view our credentialing policies and procedures, visit UHCprovider.com > Menu > Resource Library > Join Our Network.

Credentialing application: Check on your application status by calling the United Voice Portal at 1-877- 842-3210. Respond to the prompts as follows: Other Professional Services > Credentialing > Medical > Get Status.

UHCprovider.com: UHCprovider.com is your home for care provider information with 24/7 access to Link self-service tools, medical policies and news bulletins. The website offers great resources to support administrative tasks including eligibility, claims and prior authorizations and notifications.

UHCprovider.com/link: Access Link – your gateway to UnitedHealthcare’s online tools – through UHCprovider.com. With Link tools, you can get eligibility and benefit details, submit referrals, notifications and prior authorization requests, manage claims, submit claims reconsideration and appeals and even manage your demographic information that appears in our provider directory.

UHCprovider.com/edi: Submit and receive data in batch using HIPAA Electronic Data Interchange (EDI) X12 transactions for claim submissions, eligibility and benefits, claim status, authorizations, referrals, hospital admission, discharge and observation stay notifications and electronic remittance advice.

UHCprovider.com/api: Our Application Programming Interface (API) solutions allow you to electronically receive detailed data on the claims status and member eligibility and benefits. Information returned emulates data in Link and complements EDI transactions. Transfer data to your practice management or hospital information system.

In order to access secure content on UHCprovider.com or to access Link self-service tools, you’ll need to create an Optum ID. Visit UHCprovider.com/newuser.

Network News: Find health care professional news and updates for national and state Commercial, Medicare and Medicaid plans at UHCprovider.com/networknews.

Network Bulletin: News and updates regarding policy, product or reimbursement changes are posted online at UHCprovider.com/networknews. Updates are posted at the beginning of each month. Sign up to receive notification of these updates by email at UHCprovider.com/subscribe.

Most questions can be answered using our online tools at UHCprovider.com. If you need to speak with someone, we’re here to help. For state-specific contact information, visit UHCprovider.com > Menu > Contact Us.

UnitedHealthcare Web Support : 1-866-842-3278 | providertechsupport@uhc.com

Provider Services : 1-877-842-3210

Prior Authorizations: 1-877-842-3210

Optum PayTM Helpdesk: 1-877-620-6194

Provider Agreement questions: Contact your Network Management representative. To identify your Network Management representative, go to UHCprovider.com > Contact us > Find a Network Contact and select your state.

Provider Advocate: To find your provider advocate, go to UHCprovider.com > Contact Us > Find a Network Contact and select your state.

UHCprovider.com > Menu > Find a Care Provider

  • Search for doctors, clinics or facilities by plan type.
  • Find dental providers by state, network or location.

Locate mental health or substance use services.

Access benefit, coverage and identification card information.

Online: Check Eligibility and Benefits on Link. Go to UHCprovider.com and click Sign in to Link in the top right corner.

EDI: 270/271 transaction | UHCprovider.com/edi270 Phone: 1-877-842-3210

To notify us or request prior authorization:

EDI: Transactions 278 and 278N

  • Submit prior authorization requests and referrals using EDI 278 transactions. Go to UHCprovider.com/edi278 for more information.
  • Submit hospital admission, discharge and observation stay notifications using EDI 278N transactions. Go to UHCprovider.com/edi278n for more information.
  • Check the status of prior authorization requests and notifications at UHCprovider.com/edi278i.

Online: UHCprovider.com/paan

Use the Prior Authorization and Notification Tool on Link to:

  • Determine if notification or prior authorization is required.
  • Complete the notification or prior authorization process.
  • Select the Specialty Pharmacy Transactions tile on your Link dashboard. You will be directed to the new website we’re using to process these authorization requests.
  • Upload medical notes or attachments.
  • Check request status.

Information: UHCprovider.com/priorauth (information and advance notification/prior authorization lists)

Phone: Call Care Coordination at the number on the member’s ID card (self-service available after hours) and select “Care Notifications.”

EDI: UHCprovider.com/edi837 View our Claims Payer List to determine the correct Payer ID.

Online: Claims on Link at UHCprovider.com. Click Sign in to Link in the top right corner.

Information: UHCprovider.com/claims (policies, instructions and tips) Phone: 1-877-842-3210 (follow the prompts for status information) 

Reimbursement Policies:

UHCprovider.com > Policies and Protocols > Medicare Advantage Policies > Medicare Advantage Reimbursement Policies

UHCprovider.com > Policies and Protocols > Community Plan Policies > Reimbursement Policies for Community Plan

Reimbursement policies may be referred to in your Agreement as “payment policies.” Refer to the Medicare Advantage policies for DSNP members.

Online submissions are the fastest and easiest way to file Claim Reconsiderations and Appeals. Access Claims on Link at UHCprovider.com. Click Sign in to Link in the top right corner.

Report escalated or unresolved issues to your Provider Advocate by email. Submit an appeal as a final resolution.

Medical Policies: Get copies of the medical policies and guidelines at UHCprovider.com/policies.

Refer to your internal contracting contact or Provider Agreement for timely filing information.

Care Provider or Group Demographic Information Update forms: UHCprovider.com/demographics > No Access to My Practice Profile?

Claims, Billing and Payment forms: UHCprovider.com/claims > Need a Paper Form?

Prior Authorization and Notification forms: UHCprovider.com/priorauth > Forms

UHCprovider.com > Menu > Find a Care Provider > Preferred Lab Network.

Specialty Pharmacy Program provides focused support to help better manage rare and complex chronic conditions. Find details about the Specialty Pharmacy Program online at UHCprovider.com/specialtyRx.

Commercial medical benefit specialty prior authorizations are managed under the

Specialty Guidance Program (SGP).

Phone: 1-888-397-8129

Email: SpecialtyGuidanceProgram@optum.com


Testing Mounika

Testing Mounika Testing Mounika Testing Mounika Testing Mounika Testing Mounika Testing Mounika

5g Click it