Sunday, August 7, 2011

UHC insurance claim appeal - claim reconsideration

Step 1: Claim reconsideration

If you believe you were underpaid by us, the first step in addressing your concern is to request a Claim Reconsideration.

• The quickest way to submit a Claim Reconsideration request is directly through Go to  Claims & Payments  Claim Reconsideration. Please identify the specific claims in “paid” or “denied” status which you believe should be adjusted and give a description of the requested adjustment.

• If written documentation, such as proof of timely filing is needed, you must use the Claim Reconsideration
Request Form found on  Claims & Payments  Claim Reconsideration  Claim Reconsideration Request Form. The form should be mailed to the claim address on the back of the member’s health care ID card.

If you are submitting a Claim Reconsideration Request Form for a claim which was denied because filing was not timely:

1. Electronic claims – include confirmation that UnitedHealthcare or one of its affiliates received and accepted
your claim.

2. Paper claims – include a copy of a screen print from your accounting software to show the date you submitted the claim.

Note: All proof of timely filing must also include documentation that the claim is for the correct patient and the
correct visit.

• Alternatively, you can call the Customer Care number on the back of the health care ID card to request an
adjustment for issues which do not require written documentation.

• If you have issues involving twenty (20) or more paid or denied claims, aggregate these claims on the Claim Project online form and submit the form for research and review. Go to  Claims & Payments

 Claim Research Project.

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