United Healthcare's Step-By-Step Appeal Process
- Practice Solutions, LLC
- Sep 27, 2019
- 3 min read
Main Points
Walk through the instructions for UHC's appeal process very carefully. They have specific instructions that must be followed, or the appeal won't go through
Using the online portal, Link, will process much faster and you can get a higher volume of claims resolved
Make sure you have a copy of the insurance card on hand or you might send the appeal to the incorrect location
The idea of challenging the insurance company on a denial may sound like a scary process. But in reality if you stop to look at the process, you can find a clear and logical path to disputing a denial or rejection. So far, we have covered Aetna and Cigna's appeal process, this blog we will look at United Healthcare's (UHC) appeal process and advise you on the process.
First, you will want to locate the UHC appeal form. If you don't have a copy of that form, you can find it here. Once you pull up the form you will notice that this appeal form is much longer than Aetna or Cigna's appeal form.
The UHC appeal form includes several important instructions, so walk through the instructions for UHC's appeal process very carefully. They have specific instructions that must be followed, or the appeal won't go through.
The form that UHC supplies walks through the corrected claim process and the claim reconsideration process. Usually, submitted a corrected claim is the best chance of getting a claim reprocessed without having to go through the appeal process.
The claim reconsideration form is 5 pages and on the 5th page you will find the form for UHC commercial, UHC Medicare Advantage, and United Healthcare West claims. Here are some helpful tips when looking at UHC appeals:
Always submit a separate form for each claim that you are disputing
No new claims can be submitted with the form
Check your provider manual for other dispute or grievance processes
On the form, you will see 8 options for the request. On page 2 of the guide, UHC defines each one to help you determine the best selection for the denial.
Read through these carefully and make the best selection based on the explanation of benefits that you received with the denial.
Next, to mail the form, you will want to look at the Explanation of Benefits or the back of the patient's insurance ID card. UHC does not have a standard appeals mailing address, so this is a critical detail.
However, if you are mailing an appeal to the Empire Plan you can send appeals to
United Healthcare Empire Plan
PO Box 1600
Kingston, NY 12402
Filling out the form is pretty straightforward.
You will first fill out the patient's demographic information along with your NPI and Tax ID.
Then you will fill out your contact information with the expected amount owed.
Then you will select on of the eight reasons for the reconsideration
Then you will add any additional comments or additions
Finally, you will send in the appeal form to the correct location
Be sure to log the appeal in the patient's chart and set a reminder for yourself to follow up on the appeal.
When documenting your follow-ups, include the number that you called, the name of the representative that you spoke with, the content of your discussion, and the reference number for your call.
You can reference this information at a later time.
We understand that using paper for appeals can be a laborious process. This is why UHC created Link. Using the online portal, Link, will process much faster and you can get a higher volume of claims resolved.
If you are a provider with UHC then you can sign up with Link here. This system will allow you to process over 20 claims at a time and tracks the appeals for you.
This is a much faster way to go about appeals without the hassle of a paper form.
Don't hesitate to reach out to our team of professional billers if you have an appeal that is stuck in processing or you are trying to troubleshoot the process of getting sticky claims to process.
