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Claim Reconsiderations and Appeals

 

Claims Reconsiderations

To request a reconsideration or adjustment of a UnitedHealthcare claim, please review the form and reference guide below.

Claim Reconsideration Request Form (PDF 776.02 KB)
Claim Reconsideration Requests Reference Guide
(PDF 121.37 KB)

To check the status of an existing reconsideration request, please visit our secure provider portal at UnitedHealthcareOnline.com.

 

Claim Appeals

If you are not satisfied with the outcome of a claim reconsideration request, you may submit a formal claim dispute or appeal using the process outlined in our provider manual.

A formal claim dispute or appeal is a comprehensive review of the disputed claim(s), 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. We will contact you if we believe it will take longer than 30 days to render a decision.

Please allow 10 business days from the submission date to enable us to begin processing the review before requesting a status update.

Additional state requirements may apply. Please consult our provider manual for more details.

If you have questions regarding the claim appeal process, you can also contact our provider services unit at 877-842-3210.