Claims and payments

• How to submit a claim reconsideration request quick reference guide
• Claims interactive guide
• AHCCCS guidelines for ROPA care providers

To view current claim reconsideration information, sign in to the UnitedHealthcare Provider Portal.

If you're 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
• We generally complete 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 the applicable state Provider Administrative Guide or Manual for more details or contact the Provider Services Center.

Additional resources

• UnitedHealthcare Community Plan claim reconsideration form

Using EDI for all eligible UnitedHealthcare transactions can help your organization improve efficiency, reduce costs and increase cash flow. You can find more information and resources on our EDI page.

A PRA is generated for every processed claim and includes relevant details about how the claim was processed. You can access them a variety of ways, including Document Library, Electronic Data Interchange (EDI) or Application Programming Interface (API). Learn more in our PRA Overview.