How to submit a claim
How to know when to submit a claim and what happens when you do
As you're using your health plan, you may wonder how and why you may need to submit a claim. If you get your health insurance through your employer, here are some tips to help guide you.
When do I need to submit a claim?
In most cases, when you go to a network provider, you will not need to submit a claim for your care. However, there are a few occasions where submitting a claim on your own may be required, in order for you or the provider to receive reimbursement. Some examples include:1
- Dependent care. If you have an FSA account that covers reimbursement for childcare or elder care, a claim must be submitted for that reimbursement.
- Upfront billing. You may need to submit your own medical claim if you go to a provider who collects payment up front rather than billing the insurance company.
- Out-of-network. We know that as much as you try to see a network provider, sometimes it’s just not possible — like if you’re on the road or in an emergency situation. Out-of-network providers can submit a claim on your behalf. However, if the provider is unwilling to do so, you may have to submit this claim on your own.
What’s a timely filing limit?
Timely filing is the time limit a member or provider has to file a claim for health services received or provided. If the claim is not submitted during that time frame, insurance can deny the claim. This means the provider could potentially not receive payment or a member could be denied reimbursement.
How to submit claims in 2 steps
1. Sign in to your health plan account to find your submission form
Sign in to your member account and go to the “Claims & Accounts” tab, then select the “Submit a Claim” tab. You will have the option to digitally submit a form or download, print, and mail a medical claim form to the mailing address found on your member ID card.
You’ll need to include the following information on the superbill to process the claim:
- Patient name
- Provider Tax ID# (A copy of your W9 may be needed if the provider is out-of-network)
- Diagnosis codes
- Procedure codes (CPT, HCPC) - with any applicable modifiers
- Units for each procedure code
- The billed amount for each procedure code
- Place of service code
2. Submit your claim by mail
After you print and complete the Medical Claims Submission form, mail it with the claim details and receipts to the address on your health plan ID card.
Helpful hints
Here are some tips and tricks on how to make the claims process easy and efficient.
- Be sure to complete all of the applicable fields on the form. Ask your provider for the Provider Information or have them fill it out for you.
- Keep a copy of the form, claim details and receipts for your records.
- Send the claim as soon as possible, and as close to the date of service as possible.
- Complete a separate form for each claim.
- If you have other insurance or Medicare and it is primary to your UnitedHealthcare plan, include that corresponding Explanation of Benefits (EOB) with your claim.
What happens next
After your claim is processed, you’ll receive an EOB. This explains the charges applied to your deductible (the amount you pay for covered services before your plan begins to pay), plus any charges you may owe the provider. Keep your EOB on file in case you need it in the future. Sign in to your member account to review your EOB anytime.
Frequently asked questions about submitting claims
Read on to find answers to common questions about submitting claims.
In some cases, UnitedHealthcare may deny all or part of a claim. You have a right to the details about why a claim or coverage was denied. If you receive a denial letter from UnitedHealthcare, read it carefully for details on why your claim was denied. There should also be directions on how to file an internal and external appeal.
This means you’ll ask your insurance company to review its decision and reconsider. This step might mean getting and sending papers about your claim. If your internal review is rejected, you also have the right to a third-party review.
Filing a third-party review (external review)
You can send your case to a third party, who will review it and decide if the denial was right.
You can find more information in your Explanation of Benefits, claim or by calling member services.
Generally, it can take up to 30 days to get a reimbursement check after your insurance company processes a claim. Each claim time is different, but many are processed within 14 business days. Payment processing also depends on the payment method, your bank and whether all information has been verified and included.
Looking for other common health insurance forms?
View our common forms or sign in to your member account.