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Claim Submission

This action allows you to submit claims to be received and processed in real-time by a specific physician, hospital or other health care professionals and receive immediate confirmation that your request has been received and view results of the request.

Two Types of Claim Submission

1. Claim Submission/Real Time Adjudications. Most Claim Submissions will be of this type
2. NDC Provider Claim Submission. UnitedHealthcareOnline.com may determine some claims are from NDC Providers.
To get started, login to UnitedHealthcareOnline.com and select Claim Submission from the Claims & Payments drop down menu.

Step 1: Select Provider

1.Select the Corporate Tax ID Owner from the drop-down box.  If there is only one Corporate Tax ID Owner, it will be pre-populated.
2. Select the Physician/Provider Tax ID from the drop-down box.  If there is only one Physician/Provider Tax ID, it will be pre-populated.
3. Select the Physician/Provider Name from the drop-down box.  If there is only one Physician/Provider Name, it will be pre-populated.
4. Select the Physician/Provider Billing Address from the drop-down box.  If there is only one Physician/Provider Billing Address, it will be pre-populated.
5. Select the Physician/Provider Payment Address from the drop-down box.  If there is only one Physician/Provider Payment Address, it will be pre-populated. Select the Edit Payment Address for this Claim to edit the payment address.
6. Select the Physician/Provider Service Address from the drop-down menu.  If there is only one Physician/Provider Service Address, it will be pre-populated. Select the Edit Service Address for this Claim to edit the service address.
7. Enter the contact's Last Name.  This will be pre-populated with the last name of the person who logged in.
8. Enter the contact's First Name.  This will be pre-populated with the first name of the person who logged in.
9. Enter the contact Phone Number. This will be pre-populated with the phone number that is set up in the My Account section.
10. Click the Continue button.

Determining How to Continue

  •  If Step 2 of the Claim Submission process is 'Select Patient', follow the Claim Submission/Real Time Adjudication Step by Step instructions.
  •  If Step 2 of the Claim Submission process is 'Enter Member and NDC Claim Information', UnitedHealthcareOnline.com has determined the claim submitted is for an NDC provider, follow the NDC Provider Claim Submission Step by Step instructions.

Claim Submission/Real Time Adjudication

Four Steps to Claim Submission/Real Time Adjudication

1. Select Provider (already completed)
2. Select Patient
3. Enter Claim Details
4. Claim Summary & Adjudication Status

Step 2 of 4: Select Patient (required fields are marked with an asterisk.)

Note: If your patient's information cannot be retrieved and you are receiving an error message, access the web site listed on the error message or contact the customer service number listed on the back of the member's card for assistance.

Search Method 1:  Enrollee#, DOB Search

1. Select the Enrollee#, DOB Search option.
2. Enter the Enrollee Number located on the member's Medical ID Card, without hyphens or dashes.
3. Enter the Date of Birth in mm/dd/yyyy format.
4. Enter the Date to Check using the mm/dd/yyyy format or by clicking on the calendar icon.
5. Click the Search button.
6. If duplicate results occur, you will be asked to provide the patient's group number or the first two characters of the first and last name.

Search Method 2: Enrollee#, Name Search

1. Select the Enrollee#, Name Search option.
2. Enter the Enrollee Number located on the member's Medical ID Card, without hyphens or dashes.
3. Enter the patient's Last Name.
4. Enter the patient's First Name.
5. Enter the Date to Check using the mm/dd/yyyy format or by clicking on the calendar icon.
6. Click the Search button.
7. If duplicate results occur, you will be asked to provide the patient's group number or the date of birth.

Search Method 3: Alpha Search (Patient Last Name, First Name, Date of Birth & State)      

1. Select the Alpha Search option.
2. Enter the patient's Last Name.
3. Enter the patient's First Name.
4. Enter the Date of Birth in mm/dd/yyyy format.
5. Select the patient's State of residence.
6. Enter the Date to Check using the mm/dd/yyyy format or by clicking on the calendar icon.
7. Click the Search button.

Search Method 4: Swipe/Scan Health Care ID Card

1. Select the Swipe/Scan Health Care ID Card option.
2. Swipe the patient's Health Care ID card using the Swipe Card reader or scan the barcode on the patient Health Care ID card using the barcode scanner.
3. If requested, enter the patient's Date of Birth using mm/dd/yyyy format and click the Search button.

Note: If more than one family member shares the same birth date, enter the Date of Birth or First and Last names, if prompted, to search again.

Search Method 5: Recently Viewed Patients (This search method is visible during the current session.)

1. Select the patient you wish to view.  Up to ten (10) recent patients will be listed.
2. Click the Search button.

Step 3 of 4: Enter Claim Details

General Information

1. Some information may be pre-populated for you.
2. Required fields are highlighted.
3. Press the Tab key to advance fields.
4. Click radio buttons to select.

Field Specific Information

1. Box 9: Enter the Other Insured?s Last Name and First Name (required if 'Yes' is selected in Box 11D).
2. Box 9A: Enter the Other Insured?s Policy or Group Number (required if 'Yes' is selected in Box 11D).
3. Box 9C: Select the Patient Relationship to Other Insured from the drop-down box (required if 'Yes' is selected in Box 11D).
4. Box 9D: Enter the Insurance Plan Name or Program Name (required if 'Yes' is selected in Box 11D).
5. Box 10A:  Select Yes or No if the patient's condition is related to either current or previous employment.
6. Box 10B: Select Yes or No if the patient's condition is related to an Auto Accident (a selection of 'Yes' will require an entry for the Place (State) and will require field 14 to be completed).
7. Box 10C: Select Yes or No if the patient's condition is related to an Other Accident (a Yes' selection will require field 14 to be completed).
8. Box 10D: Select Yes or No if Another Party is Responsible (a 'Yes' selection will require field 14 to be completed).
9. Box 11D: Select Yes or No to indicate if there is Another Health Benefit Plan (a 'Yes' selection will require field 9A-9D, and the Other Payer Information section to be completed)
10. Box 14: Enter the Date of the Current Illness, Injury or Pregnancy and select the appropriate qualifier from the drop list.
11. Box 20: Select Yes or NO to indicate if an Outside Lab was used. If 'Yes', enter the dollar amount of the charges.
12. Box 21: Enter the Diagnosis Code or click on the magnifying glass.
13. Box 24A: Enter the Date of Service using the MM | DD | YYYY format.
14. Box 24D: Enter the CPT/HCPCS Code or click on the magnifying glass to look up code
15. Box 24E: Select the checkbox to indicate the Diagnosis Pointer(s).
16. Box 24F: Enter the dollar amount of the charges.
17. Box 24G: Enter the Days or Units.
18. Box 24K: Enter the patient's hematocrit (HCT) level, if applicable.
19. Box 24: Select the NOTE REFERENCE CODE from the drop down list. The NOTE REFERENCE CODE is used to indicate the type of note that you will enter in the text box.   Reference Code definitions are:

  • ADD - Additional Information
  • DCP - Goals, Rehabilitation Potential or Discharge Plans
  • PMT - Payment
  • TPO - Third Party Organization Notes

20. Box 26: Enter the patient's account number.

21. Box 27:  Select Yes or Not for Accept Assignment.

22. Box 24: Select the CLAIM NOTE REFERENCE CODE from the drop down list. The CLAIM NOTE REFERENCE CODE is used to indicate the type of note that you will enter in the text box.   Reference Code definitions are:

  • ADD - Additional Information
  • CER - Certification Narrative
  • DCP - Goals, Rehabilitation Potential or Discharge Plans
  • DGN - Diagnosis Description
  • PMT - Payment
  • TPO - Third Party Organization Notes

23. Report Type Code definitions are displayed in the drop down list.

24. Report Transmission Code definitions:

BM - By Mail

  • FX - By Fax

25. Attachment Control Number will be required if the Report Type Code and Report Transmission Code are selected.  This number can be alpha/numeric and can up to 80 bytes in length.

26. Box 33: Enter the Physician/Provider's National Provider Identifier (NPI) number.
27. Box 33: When the physician/provider?s billing address has a state value of MN, box 33 is required.
28. Box 33: When the physician/provider?s service address has a state value other than MN, box 33 is optional.
29. Box 34: Enter the Rendering Physician Information. This field is only needed if the information is different from the Physician/Supplier billing information in box 33.

Other Payer Information section

1. Select the Insurance Type Code from the drop-down box.
2. Enter the Adjudication or Payment Date in a MM | DD | YYYY format.
3. Select Yes or No to indicate Other Insurance Assignment of Benefits.
4. Enter the Other Insured's ID Number.
5. Select the Other Insurance Release of Information Code from the drop-down box.
6. Select the patient Signature Source Code from the drop-down box.
7. The Date(s) of Service, Place of Service, Type of Service and CPT/HCPCS data will be pre-populated based in information already entered.
8. The Claim Group Code Line:

  1. Select the Claim Adjustment Reason Code from the drop-down box, If applicable.
  2. Enter the Other Reason Code (required when Other is selected from the drop-down boxes). Select the column header to open a .pdf file containing the Other Reason Codes and descriptions.
  3. Enter the Primary Insurance Adjustment Amount (sum of all non-patient responsibility amounts), if applicable.

9. The Patient Responsibility Code Line:

  1. Select the Claim Adjustment Reason Code from the drop-down box, if applicable.
  2. Enter the Other Reason Code (required when Other is selected from the drop-down boxes). Select the column header to open a .pdf file containing the Other Reason Codes and descriptions.
  3. Enter the Patient Responsibility Amount (sum of all patient responsibility amounts).

10. Enter the Primary Insurance Adjustment Amount and the Primary Insurance Paid Amount.

Additional Information

  • If no information is entered, the Physician/Supplier billing information will be defaulted.
  • If all required fields are not filled in, an error message will display (i.e. 24.D CPT/HCPCS is required).
  • To submit the claim, click the Submit Claim button.
  • To print a copy of the HCFA form click on the Print button.
  • To begin a new claim, click on the Start A New Claim button.  Any information entered, will not be saved if the Start A New Claim button is selected.

Step 4 of 4: Claim Summary & Adjudication Status

1. Click on the Printer Friendly Page link to print a copy of the summary.

2. Click on the Submit New Claim For Same Member, Same Provider button to submit a new claim.

Adjudication Result: Successful

1. Adjudication Result will read Successful and you may view the full detail of the adjudicated claim if the claim was successfully adjudicated at the point-of-service.

2. To print the Confirmation Page to give to the patient, click the Print Patient Confirmation (set the page layout to Landscape.)

3. Select the Printer Friendly Page link to print a copy of the success page for your records.

Result: Accepted

4. Result will read Accepted if the claim was accepted for processing, but not successfully adjudicated at the point-of-service.

5. You will be able to see a summary of the submitted claim information.

6. Print a copy of the summary screen by clicking the Printer Friendly Page link.

NDC Provider Claim Submission

Note: Real Time Adjudication is not available with NDC Provider Claim Submission.

Three Steps to NDC Provider Claim Submission

1. Select Provider (already completed)
2. Enter Member and NDC Claim Information
3. Confirmation Receipt & Summary

Step 2 of 3: Enter Member and NDC Claim Information

General Information

1. Required fields are highlighted.
2. Press the Tab key to advance fields.
3. Click radio buttons to select.

Required Field Specific Information

1. Field 1a. Enter the insured's ID Number (required).
2. Field 2. Enter patient's name (required).
3. Field 3. Enter patient's birth date and select the patient's gender from the drop down menu (required).
4. Field 4. Enter the insured's name (required).
5. Field 5. Enter the patient's address (required).
6. Field 6a. Select the patient's relationship to insured. Available options are self, spouse, child. If the patient is the same person as the insured, select 'self'. This will cause the patient information to be copied to the appropriate Insured labeled fields.  If the patient is not the same person as the insured, select 'spouse' or 'child, as appropriate and then enter the Patient and Insured field information.
7. Field 7. Enter insured's address (required).
8. Box 9: Enter the Other Insured's Last Name and First Name (required if 'Yes' is selected in Box 11D).
9. Box 9A: Enter the Other Insured's Policy or Group Number (required if 'Yes' is selected in Box 11D).
10. Box 9C: Select the Patient Relationship to Other Insured from the drop-down box (required if 'Yes' is selected in Box 11D).
11. Box 9D: Enter the Insurance Plan Name or Program Name (required if 'Yes' is selected in Box 11D).
12. Box 10A:  Select Yes or No if the patient's condition is related to either current or previous employment.
13. Box 10B: Select Yes or No if the patient?s condition is related to an Auto Accident (a selection of 'Yes' will require an entry for the Place (State) and will require field 14 to be completed).
14. Box 10C: Select Yes or No if the patient's condition is related to an Other Accident (a 'Yes' selection will require field 14 to be completed).
15. Box 10D: Select Yes or No if Another Party is Responsible (a 'Yes' selection will require field 14 to be completed).
16. Box 11D: Select Yes or No to indicate if there is Another Health Benefit Plan (a 'Yes' selection will require field 9A-9D, and the Other Payer Information section to be completed
17. Field 11. Enter Insured?s Policy Group or FECA Number (required).
18. Field 11c. Select the Insurance Plan or Program Plan name (required).
19. Field 20. Select if an outside lab was used (required).
20. Field 21. Enter the Diagnosis code. Search by selecting the magnifying glass icon (required)
21. Field 24. When the NDC Code is populated on the line, the CPT/HCPCS may be populated but it is not required. If NDC Code is not populated on the service line then CPT/HCDPCS is required. Enter the NDC Code as 11 digits- dashes are not allowed.
22. Field 26. Enter the Patient?s Account No. (required).
23. Field 27. Select Yes or No to Accept Assignment (required).
24. Select Print to print a copy of the claim for your records; Select Submit Claim to submit the claim; To begin a new claim, click on the Start A New Claim button.  Any information entered, will not be saved if the Start A New Claim button is selected.

Other Payer Information section

1. Select the Insurance Type Code from the drop-down box.
2. Enter the Adjudication or Payment Date in a MM | DD | YYYY format.
3. Select Yes or No to indicate Other Insurance Assignment of Benefits.
4. Enter the Other Insured's ID Number.
5. Select the Other Insurance Release of Information Code from the drop-down box.
6. Select the patient Signature Source Code from the drop-down box.
7. The Date(s) of Service, Place of Service, Type of Service and CPT/HCPCS data will be pre-populated based in information already entered.
8. The Claim Group Code Line:

    1. Select the Claim Adjustment Reason Code from the drop-down box, If applicable.
    2. Enter the Other Reason Code (required when Other is selected from the drop-down boxes). Select the column header to open a .pdf file containing the Other Reason Codes and descriptions.
    3. Enter the Primary Insurance Adjustment Amount (sum of all non-patient responsibility amounts), if applicable.
    4. The Patient Responsibility Code Line:
    5. Select the Claim Adjustment Reason Code from the drop-down box, if applicable.
    6. Enter the Other Reason Code (required when Other is selected from the drop-down boxes). Select the column header to open a .pdf file containing the Other Reason Codes and descriptions.
    7. Enter the Patient Responsibility Amount (sum of all patient responsibility amounts).

9. Enter the Primary Insurance Adjustment Amount and the Primary Insurance Paid Amount.

Step 3 of 3: Confirmation Receipt & Summary

Note: Real Time Adjudication is not available with NDC Provider Claim Submission.

1. Click on the Printer Friendly Page link to print a copy of the claim summary for your records.
2. Select the Submit New Claim for Same Member, Same Provider button to return to Step 2 with the Provider, Patient and Insured fields populated for convenience.

Claim Accepted Status

1. Status will read Successful.
2. You will be able to see a summary of the submitted claim information.
3. Print a copy of the summary screen by clicking the Printer Friendly Page link.

  See Also