Here you will find the tools and resources you need to help manage your practice’s submission of claims and receipt of payments. Our self-service resources for claims include using Electronic Data Interchange (EDI) and the claimsLink tool in Link.
UnitedHealthcare is launching initiatives to replace paper checks with electronic payments. As part of these efforts, we are encouraging both in-network and out-of-network providers to sign up for electronic payments, specifically by automated clearing house (ACH)/direct deposit. If you don’t elect to sign up for ACH/direct deposit, you may receive Virtual Card Payments in place of paper checks. The alternative to a Virtual Card Payment is direct deposit.
Virtual Card Payments are subject to the terms and conditions governing card processing between you and your card service processor, and you are responsible for any charges and related third party fees, including interchange, merchant discount, or other card processing fees. Consult your merchant processor or financial institution for the specific fees. OptumHealth Financial Services, a United-affiliated company, provides payment services to the healthcare industry and offers various claim payment options. United-affiliated companies may receive transaction fees or other compensation related to some payment options.
Florida, New Mexico, New York or Oregon out-of-network providers and all Colorado, Georgia, and New Jersey providers have to consent to receive a virtual card payment.
Processing of the Virtual Card Payment is your consent to receive and accept it as payment in full from the payer. If you don’t consent, when you receive a Virtual Card Payment, please call the number provided on your Virtual Card Payment to arrange an alternative payment method.
You should submit an Appeal using the File Appeal button in Claims (on Link) when available, should you wish to challenge a decision or request an exception. Situations for reprocessing include, but are not limited to:
Medical necessity (must be filed as a member appeal and can be submitted by the member or by the provider on their behalf)
Need a paper form because you are unable to submit your appeal online?
At this time, the Claim Research tool on Link does not include support for UHCWest care providers. To submit multiple claims as a UHCWest care provider, please fill out and email both the Claims Project Management Request Form and the Multiple Claims Inquiry Spreadsheet found below to ProjectIntake@uhc.com.
The Claims (on Link) tool allows you to submit and track claim reconsideration requests. It replaces the Claim Status and Claim Reconsideration options on UnitedHealthcareOnline.com and the Claims Management and Claims Reconsideration tools on Link.
Use the links on this page to access more resources or to go directly to the Claims (on Link) tool.
Quickly receive an estimate of a UnitedHealthcare Commercial claim reimbursement and share the estimated cost of a procedure with your patient before treatment. Use claim bundling logic for professional claims and determine how the CPT or HCPCS codes will be paid.
The Electronic Payments & Statements (EPS) tool on Link lets you select your payment method, view payments, search remittances, print Electronic Remittance Advices (ERAs) and more. Enrolling online is simple and easy. Before you begin, read the EPS Enrollment Instructions and have the following handy:
Bank account and routing numbers for direct deposit
A voided check or bank letter to verify bank account information
The UnitedHealthcare West Electronic Funds Transfer (EFT) Enrollment tool allows you to enroll or make changes to EFT and 835s from the Link dashboard for your UnitedHealthcare West claims. Enrollment in UnitedHealthcare West EFT currently applies to payments from SignatureValue and Medicare Advantage plans.*
You will continue to receive checks by mail until you complete your enrollment using the UnitedHealthcare West EFT tool.
* UnitedHealthcare West EFT Enrollment and Electronic Payments and Statements (EPS) are two separate tools for different health plans. Use the UnitedHealthcare West EFT tool for Signature Value and Medicare Advantage plans only.
Look up contracted rates for CPT and HCPCS codes whose rates are dollar amounts or a percentage of charges for a specific provider and name. (Available only for Commercial and some Community Plan states.)
OneNet PPO maintains the OneNet PPO Workers’ Compensation Network, a network of physicians, health care practitioners, hospitals and ancillary facilities used for work-related illness and injury. The network serves workers’ compensation programs administered by employers and TPAs contracted with Procura, an Optum Company.
For information about OneNet PPO and OneNet workers’ compensation claim pricing sheets for Procura, access the OneNet PPO Pricing on Link.
UnitedHealthcare West Misdirected Claim Returns to the Health Plan Coversheets
If the Health Plan forwarded claims to you that you believe are the Health Plan’s responsibility according to the Division of Financial Responsibility (DOFR), please return the claims with the appropriate coversheet below. This will ensure the claims get to the correct team for processing: