United Healthcare Community Plan Reviews

Claim Administrative Disputes/Appeals

If you should be unsatisfied with all the outcome of a Claim Reconsideration Request, you could publish an official Claim Dispute/Appeal making use of the procedure outlined in your supplier manual.

An official Claim Dispute/Appeal is a comprehensive report about the disputed claim(s), and may even include a review of additional administrative or medical files by a clinician or any other employees.

UnitedHealthcare Community Arrange typically completes the review within 30 calendar days. However, with regards to the nature of the analysis, a choice might take as much as 60 times from receipt associated with claim dispute documents. We will get in touch with you if we believe it may need longer than thirty day period to make a determination.

Please allow 10 company times from distribution time make it possible for us to begin processing the review before asking for a condition enhance.

Additional condition needs may apply. Kindly consult the applicable state company Administrative Guide or handbook to get more details.