May 1: Electronic reconsideration and appeal submissions required
Affects Massachusetts and Mississippi Medicaid
Starting May 1, 2024, you’ll be required to submit claim reconsiderations and medical pre- and post-service appeals electronically. This change affects most* network health care professionals (primary and ancillary) and facilities that provide services to UnitedHealthcare Community Plan (Medicaid) members in Massachusetts and Mississippi.
If you use an outside vendor, such as a revenue cycle management company, please ensure they’re aware of the following changes and digital workflow options.
How to submit a pre-service appeal
Use the Prior Authorization and Notification tool through the UnitedHealthcare Provider Portal:
- From any page on UHCprovider.com, select Sign In at the top-right corner
- Enter your One Healthcare ID and password
- New users who don’t have a One Healthcare ID: Visit UHCprovider.com/access to get started
- In the menu, select Prior Authorizations
- Scroll down to “View Status of existing submissions, drafts and make updates” and click “Search Existing Submissions & Drafts”
- Find your service reference number (SRN) and expand to see the details
- If the details show the coverage status as “Not Covered/Not Approved,” you’ll see the “File a Pre-Service Appeal or a Grievance” link
- You can also click on the SRN to see the originally entered case details, as well as the “File a Pre-Service Appeal or a Grievance” link under the coverage status section
- Once you click the link, a new tab will open that takes you to the instructions page of the submission form
- You will be guided to complete the form, upload any supporting documents, review your information and submit
- Use Advanced Filter to search Document Library for your pre-service appeal letters
How to submit claim reconsiderations, post-service appeals
Use one of the following options:
- From any page on UHCprovider.com > Sign In
- Enter your One Healthcare ID and password
- Users who don’t have a One Healthcare ID: Visit UHCprovider.com/access to get started
- In the menu, click Claims & Payments > Look up a Claim to search by the claim number and click Act on Claim
- Enter your One Healthcare ID and password
- Application Programming Interface (API): API is a fully electronic digital solution that allows you to automate administrative transactions. This is a great alternative to Document Library for organizations with medium-to-high claim volume that have the technical resources to program API or the ability to outsource implementation.
Get started with API.
Questions? We're here to help
Chat with a live advocate 7 a.m.–7 p.m. CT in the UnitedHealthcare Provider Portal.
For help accessing the portal, technical issues and changing notification preferences, please contact UnitedHealthcare Web Support at 866-842-3278, option 1, 7 a.m.–9 p.m. CT, Monday–Friday.
You can also contact UnitedHealthcare Provider Services at 877-842-3210, TTY/RTT 711, 7 a.m.–5 p.m. CT, Monday–Friday.
* Exclusions: Behavioral health professionals and facilities and home- and community-based services.
PCA-1-24-00042-POE-NN_01172024
