UnitedHealthcare billing and credentialing
Billing and credentialing for UnitedHealthcare commercial, Medicare Advantage and Community Plan (Medicaid) members.
Working with UnitedHealthcare
UnitedHealthcare is the largest health insurer in the US and one of the largest Medicare Advantage carriers. Its Medicaid plans operate as UnitedHealthcare Community Plan, and behavioral health benefits are often managed by Optum.
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Plan types we bill:
- Commercial (employer and individual)
- Medicare Advantage and Dual Complete
- Community Plan (Medicaid)
- Behavioral health through Optum
Credentialing and enrollment
Credentialing uses your CAQH ProView profile, so it must be complete, attested within the last 120 days and authorized for the payer before the application is reviewed.
Prepare
Licenses, NPI, CAQH and group details checked and updated.
Apply
Application submitted for each provider and location.
Follow up
Status checked every 1 to 2 weeks until approval.
Confirm
Effective date and participation confirmed before billing.
Claims, eligibility and portals
Eligibility, claim status, prior authorization and appeals are handled through the UnitedHealthcare Provider Portal. Filing limits are set by your agreement and plan type, so we track each one.
Denials we prevent with UnitedHealthcare
- Provider not credentialed or not linked to the group TIN
- Missing prior authorization for services on the payer’s list
- Eligibility or coordination of benefits issues
- Coding edits and bundling under payer policy
- Claims filed after the contract’s filing limit
- Behavioral health claims sent to UnitedHealthcare instead of Optum
Questions about UnitedHealthcare
Is UnitedHealthcare credentialing the same for Medicaid and commercial?
Not always. Community Plan participation can require separate steps in some states.
Other payers and related services
Trademarks belong to their owners. MedAi Billing Solutions is an independent billing company, not affiliated with any payer or government agency.
Get help with UnitedHealthcare claims
Send a few details and we will set up a short call to review your claims, denials and A/R. No cost and no commitment.
We sign a Business Associate Agreement before we handle any patient data.