- Provider Information
- Billing and Reference Guides
- Claim Reconsideration and Appeals
- Claims and Member Information
- Clinical Practice Guidelines
- Cultural Competency Library
- Dual Complete (HMO-SNP) Program
- Electronic Data Interchange (EDI)
- Pharmacy Program
- Provider Administrative Manual
- Provider Forms
- Provider Training
- Reimbursement Policy
Claims Reconsideration and Appeals
To view up to date Claim Reconsideration information go to UnitedHealthcareOnline.com.
Claim Administrative Disputes/Appeals
If you are not satisfied with the outcome of a Claim Reconsideration Request, you may submit a formal Claim Dispute/Appeal using the process outlined in your provider manual.
A formal Claim Dispute/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. Consult the applicable state Provider Administrative Guide or Manual for more details.
For more information please contact the provider services center.