Complete claims
For proper payment and application of deductibles and coinsurance, it is
important to accurately code all diagnoses and services (according to
national coding guidelines). It is particularly important to accurately code
because a member’s level of coverage under his or her benefit plan may
vary for different services. You must submit a claim for your services,
regardless of whether you have collected the copayment, deductible or
coinsurance from the member at the time of service.
To assist you in understanding how your claims will be paid, UnitedHealthcare’s
Claim Estimator includes a feature called Professional Claim Bundling
Logic which helps you determine allowable bundling logic and other
claims processing edits for a variety of CPT (CPT is a registered trademark
of the American Medical Association) and HCPCS procedure codes. Note: Only
bundling logic and other claims processing edits are available under this
option.
Allow enough time for your claims to process before sending second submissions
or tracers, then check their status online at UnitedHealthcareOnline.com.
If you do need to submit second submissions or tracers, be sure to submit
them electronically no sooner than forty-five (45) days after original submission.
Complete claims include the information listed under the Complete Claims
Requirements section of this Guide.
We may require additional information for particular types of services, or
based on particular circumstances or state requirements.
Electronic Claims Submission (EDI ). If
you need additional information on EDI , contact the EDI Support Line at
(800) 842-1109, Option 3.g Claims and Payments gIf you have questions about submitting claims
to us, please contact Customer Care at the phone number listed on
the member’s health care ID card. For questions specific to electronic
submission of claims, please review the information at
UnitedHealthcareOnline.com
Learn about the many tools available to help you prepare, submit and manage
your UnitedHealthcare claims at UnitedHealthcareOnline.com including:
Claim Estimator with bundling logic and Real-Time Adjudication. Training
tools and resources including Frequently Asked Questions (FAQs), Quick
References, Step-by-Step Help and Tutorials are available by clicking
“Help” at the top of any page.
Note: At the time of publication of this Guide, the Claim Estimator is not
available for Medicare products.
To order 1500 HIC F (CMS-1500) and UB-04 (CMS-1450) forms, contact the U.S.
Government Printing Office, call (202) 512-0455, or visit their Web site
at cms.hhs.gov/CMSForms.
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