Claims, Billing and Payments

Here you will find the tools and resources you need to help manage your practice’s submission of claims and receipt of payments. Our self-service resources for claims include using Electronic Data Interchange (EDI) and the Claims tool in UnitedHealthcare provider portal.

UnitedHealthcare is launching initiatives to replace paper checks with electronic payments. As part of these efforts, we are encouraging both in-network and out-of-network providers to sign up for electronic payments, specifically by automated clearing house (ACH)/direct deposit. If you don’t elect to sign up for ACH/direct deposit, you may receive Virtual Card Payments in place of paper checks. The alternative to a Virtual Card Payment is direct deposit.

Virtual Card Payments are subject to the terms and conditions governing card processing between you and your card service processor, and you are responsible for any charges and related third party fees, including interchange, merchant discount, or other card processing fees. Consult your merchant processor or financial institution for the specific fees. Optum Financial™, a United-affiliated company, provides payment services to the healthcare industry and offers various claim payment options. United-affiliated companies may receive transaction fees or other compensation related to some payment options.

Florida, New Mexico, New York or Oregon out-of-network providers and all Colorado, Georgia, and New Jersey providers have to consent to receive a virtual card payment.

Processing of the Virtual Card Payment is your consent to receive and accept it as payment in full from the payer. If you don’t consent, when you receive a Virtual Card Payment, please call the number provided on your Virtual Card Payment to arrange an alternative payment method.

Please visit Electronic Payment Solutions for more information on payment options.

What Would You Like to Do?

Check Claim Status

Submit a Claim

Optum Pay

To see more information on any of these areas, click on the plus sign (+) next to their title.

With the Claims tool, you can:

  • View claims information for multiple UnitedHealthcare® plans
  • Access letters, remittance advice documents and reimbursement policies
  • Submit additional information requested on pended claims
  • Flag claims for future viewing
  • Submit corrected claims or claim reconsideration requests
  • Receive instant printable confirmation for your submissions

To check the status of claims using Electronic Data Interchange (EDI), visit the EDI 276/277 Claims Status page.

Want Personalized EDI Tips?

We'll review your single-page CMS-1500 paper claim submission and give you tips for submitting them electronically. Send a secure email with your tax ID number to us to get started.

With the Claim Submission Tool You Can:

  • Submit professional claims, including National Drug Code (NDC) claims, for all UnitedHealthcare members
  • Easily see which fields are required. The highlighted fields will update based on the information you enter
  • View on-screen messages that allow you to correct certain errors before you hit submit
  • Eliminate paper, postage and mail time

To learn about claim submission methods and connections using Electronic Data Interchange (EDI), visit the EDI 837: Electronic Claims> page for more information.

You can use the Claims tool to submit a corrected claim or claim reconsideration and track claim reconsideration requests. 

When Should You Submit a Claims Reconsideration?

You should submit a claims reconsideration request through the Claims tool when you believe a claim was paid incorrectly. Situations for reprocessing include, but are not limited to:

  • Amount is different than what provider expected
  • Claim was filed in a timely manner, when provider has proof
  • Claim was denied for no authorization, when provider has an authorization number
  • Difference in Coordination of Benefits (COB) information 

Need a paper form because you are unable to submit your reconsideration online? Use our Single Paper Claim Reconsideration Request Form instead. 

When Should You Submit an Appeal?

You should submit an Appeal using the File Appeal button in Claims tool when available, should you wish to challenge a decision or request an exception. Situations for reprocessing include, but are not limited to:

  • Medical necessity (must be filed as a member appeal and can be submitted by the member or by the provider on their behalf) 

Need a paper form because you are unable to submit your appeal online?

Where to Send Your Paper Appeal: Please send your request to the claim address on the back of the member's ID card.

New Jersey Provider Commercial Plan Providers:

  • New Jersey Provider Application to Appeal a Claims Determination for Commercial Plans, Including UnitedHealthcare Oxford Health Plans®
  • Notice - New Jersey Provider Application to Appeal a Claims Determination

The Claim Research Project tool lets you search for and submit a reconsideration request for multiple claims with the same reason for denial.

The Claims tool allows you to submit and track claim reconsideration requests. 

Quickly receive an estimate of a UnitedHealthcare Commercial claim reimbursement and share the estimated cost of a procedure with your patient before treatment. Use claim bundling logic for professional claims and determine how the CPT or HCPCS codes will be paid.

Direct Connect is a free online tool that helps you review and resolve overpaid claims quickly and easily. Using Direct Connect, you can track and manage overpayment requests, dispute an overpayment finding and submit refunds – reducing the letters and calls you receive from UnitedHealthcare, or the need to work with third-party vendors.

Direct Connect is available on the UnitedHealthcare provider portal. To get started, simply email directconnectaccess@optum.com. Please include the requestor’s name as well as the organization’s TIN(s), physical address and mailing address.

Optum Pay lets you select your payment method, view payments, search remittances, print Electronic Remittance Advices (ERAs) and more. Enrolling online is simple and easy. Before you begin, read the Optum Pay Enrollment Instructions and have the following handy:

  • Bank account and routing numbers for direct deposit
  • A voided check or bank letter to verify bank account information
  • A copy of your practice or facility’s W-9 form
  • Optum Pay Resources

For more information on using the ERA/835 EDI transaction to auto-post claim payments or for tips on how to work with 835 files, visit the EDI 835: Electronic Remittance Advice (ERA) page.

Look up contracted rates for CPT and HCPCS codes whose rates are dollar amounts or a percentage of charges for a specific provider and name. (Available only for Commercial and some Community Plan states.)

If you are new to the Fee Schedule Lookup, use the Fee Schedule Lookup Quick Reference Guide to get started.

Physician Fee Source Links

As referenced in the Market Standard Pricing Schedule (MSPS) Payment Appendix Document, information about our Physician Fee Schedule Fee Sources can be located at:

OneNet PPO maintains the OneNet PPO Workers’ Compensation Network, a network of physicians, health care practitioners, hospitals and ancillary facilities used for work-related illness and injury. The network serves workers’ compensation programs administered by employers and TPAs contracted with Procura, an Optum Company.

For information about OneNet PPO and OneNet workers’ compensation claim pricing sheets for Procura, access the OneNet PPO Pricing. 

If you are new OneNet PPO Pricing, use the OneNet PPO Pricing Status Quick Reference Guide to get started.

Optum Pay lets you select your payment method, view payments, search remittances, print Electronic Remittance Advices (ERAs) and more. For Premium users there may be a cost association. 

With our UnitedHealthcare Provider Portal, you can access most historical remittance and claims payment data, search remittances, print ERAs and more – at no charge.

Optum Pay lets you select your payment method, view payments, search remittances, print Electronic Remittance Advices (ERAs) and more. For Premium users there may be a cost association. 

With our UnitedHealthcare Provider Portal, you can access most historical remittance and claims payment data, search remittances, print ERAs and more – at no charge.

Optum Pay lets you select your payment method, view payments, search remittances, print Electronic Remittance Advices (ERAs) and more.

The Single Explanation of Benefit (EOB) Search is available to all care providers, including those not enrolled in Optum Pay.

Use the OPG Exhibits to determine reimbursement for outpatient procedures. The exhibits list valid CPT/HCPCS codes and indicate which codes are eligible for reimbursement.

If a code is eligible for reimbursement, then the grouper level is listed.

The first tab shows the complete OPG Exhibit and the second tab lists the changes to impacted codes from one period to another. For your convenience, all available Exhibits are listed here.

Optum Pay lets you select your payment method, view payments, search remittances, print Electronic Remittance Advices (ERAs) and more.

Optum Pay Resources

If the Health Plan forwarded claims to you that you believe are the Health Plan’s responsibility according to the Division of Financial Responsibility (DOFR), please return the claims with the appropriate cover sheet below.  This will ensure the claims get to the correct team for processing: