UnitedHealthcare Community Plan
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Provider Claim Review Processes

 

Claims Reconsiderations/Adjustments

To view up to date Claim Reconsideration information go to UnitedHealthcareOnline.com.

 

Claim Administrative Disputes/Appeals

A formal claim dispute is a comprehensive review of the disputed claim or claims, and may involve a review of additional administrative or medical records by a clinician or other personnel.

UnitedHealthcare Community Plan generally completes the review within 30 calendar days. However, depending on the nature of the review, a decision may take up to 60 days from the receipt of the claim dispute documentation.

Please allow 10 business days from this submission to enable us to begin processing the review before calling our Provider Services call center to request a status update.