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At UnitedHealthcare, we are committed to improving the health care system.
UnitedHealthcare is an operating division of UnitedHealth Group, the largest single health carrier in the United States.
As a recognized leader in the health and well-being industry, we strive to:
- Improve the quality and effectiveness of health care for all Americans
- Enhance access to health benefits
- Create products and services that make health care more affordable
- Use technology to make the health care system easier to navigate
Our family of companies delivers innovative products and services to approximately 70 million Americans. UnitedHealthcare's nationwide network includes 768,471 physicians and health care professionals, 80,000 dentists and 5,675 hospitals. Our pharmaceutical management programs provide more affordable access to drugs for 13 million people.
We're committed to the delivery of quality care and its continual improvement. In fact, UnitedHealth Group made significant investments in research and development, technology and business process improvements – nearly $3 billion in the past five years. These investments led to changes that are improving the way care is delivered and administered across the entire industry.
- Dental Benefit Providers of California
- Dental Benefit Providers of Illinois
- National Pacific Dental
- Nevada Pacific Dental
- Pacific Union Dental
- AARP Medicare Complete
We also have a variety of private label plans that will not show the UnitedHealthcare logo. Please refer to the member's card for contact information for those particular members.
UnitedHealthcare offers an array of insurance plans, including dental plans. We also have traditional employer based plans as well as plans that are administered for the Medicare and Medicaid demographics. While most of our plans are the traditional PPO plans, in select areas, we offer DHMO, Direct Compensation, Discount and In Network Only plans.
We offer plans throughout the United States. While some plans are specific to geographical areas, we do have plans with nationwide coverage. To obtain more information, you can contact our customer service team for further assistance.
Essential Health Benefit plans are those that were created due to the Affordable Care Act. The plans are offered through the "Marketplace". These plans were created to have certain dental benefits embedded with the member's medical plan to ensure coverage for certain services. Every medical plan purchased through the marketplace will have certain dental coverage for pediatric benefits; however, that does not mean that the member has a fully insured dental plan.
Discount plans not traditional plans and are not fully insured. Therefore, instead of filing a claim, the member would pay you directly based on a discounted rate. These members purchase these plans as well.
Please click here and you will be routed to the Medicare page to learn more.
There are two forms of self-service for checking eligibility for benefits.
1. UHCdental.com Portal
Upon login, you will be taken to a dashboard. The dashboard will allow you to conduct several tasks such as eligibility and claims searches. If you are not at the dashboard and wish to check eligibility for a patient, you can click on Dashboard or Search in the top menu.
2. Electronic Data Interchange (EDI)
EDI is set up via your practice management system and can be used for batch transactions. To find out more about the benefits, setting up, and troubleshooting EDI, click here.
If a member is eligible for benefits, a column will reflect "Y" in the Eligible Column on the Eligibility Summary Screen.
The information obtained during the benefit breakdown prior to services rendered is not a guarantee of benefits. Therefore, it is important to fully disclose this to the member with the appropriate financial disclosures that your office makes available. If the benefits are not covered due to termination of benefits, your patient is responsible for the billed for the full amount of services rendered.
We work in tandem with Dental XChange to allow dental offices to obtain eligibility for more than one member at a time. Please click here to learn more about Dental XChange.
Upon login, you will be taken to a dashboard. It has several functions, one being that you can check on the last claims paid. You can also search claims by a member specifically. If you happen to be on a page that is not the Dashboard, you can either click on Dashboard or Search on the top menu.
You can check back on past claims up to two years from the current date.
Due to privacy restrictions, we cannot show claims that were not paid to your office. However, you can check to see if a service was rendered previously to determine the member's out of pocket costs. To do that, please check eligibility for the member. On the Eligibility Summary screen, select Utilization History on the Transaction drop down menu.
Our electronic payor ID for our commercial plans is 52133. Please note that if your patient is a Medicaid patient, the payor ID will be different. Please contact our customer service team for more detailed information.
We have a variety of addresses to mail claims based on the client. Click here to see the most common addresses where a claim can be submitted.
At this time, we do not accept faxed claims.
Depending on the services rendered, we may require additional information in order to properly adjudicate the claim. Please click here to learn more about the requirements.
Yes, depending on the services performed, will have the claim reviewed by a dental consultant. The team that reviews these claims are dentists themselves and base the decisions on specific criteria about the specific ADA code. To learn more about the review criteria, click here.
Pre-Treatment Estimates or Prior Authorizations can be submitted electronically or by paper. If you are submitting a paper claim, submit to our PTE/Prior Authorization Mailbox to ensure the most efficient processing of your claim. The address for mailing Pre-Treatment estimates and Prior Authorizations is:
PTE/Prior AuthorizationsP.O. Box 30552
Salt Lake City, UT 84130-0552
We may require additional information to make a determination. Pre-Treatment estimates are valid for 90 days from the decision date.
Prior Authorization Review Statistics
The following information is provided to comply with a regulatory requirement for States requiring disclosure of information for services that require pre-service review.
- Q4 2019 AR Prior Utilization Review Statistics
- Q3 2019 AR Prior Utilization Review Statistics
- Q2 2019 AR Prior Utilization Review Statistics
- Q1 2019 AR Prior Utilization Review Statistics
- Q4 2018 AR Prior Utilization Review Statistics
- Q3 2018 AR Prior Utilization Review Statistics
- Q2 2018 AR Prior Utilization Review Statistics
- Q1 2018 AR Prior Utilization Review Statistics
- Q4 2017 AR Prior Utilization Review Statistics
- Q3 2017 AR Prior Utilization Review Statistics
- Q2 2017 AR Prior Utilization Review Statistics
- Q1 2017 AR Prior Utilization Review Statistics
We do have a specialty referral process for many DHMO and Direct Compensation plans. The process may be different depending on the plan. Please contact our customer service team for detailed information on this process.
You may submit claims online with uhcdental. Please click here for more information and to submit claims.*Please note that the online submission tool is unavailable for Medicaid Claims
We use DentalXChange ,Tesia's Attachment Service and NEA FastAttach to receive supporting documentation online.
YES! Your organization can enroll for direct deposit of claim payments! To learn more about electronic payment solutions offered by Optum, please go to www.Optum.com/EPS. If your organization is ready to enroll, please visit our online enrollment application, www.Optum.com/Enroll. The online enrollment process is short, simple and safe and all applications are processed within five business days. If at any time you have questions we’re just a phone call away: 1-877-620-6194.
The fundamental difference between these two features is the availability of real time information. The Fee Schedule Selection screen will only show your current fee schedule. The Procedure Code Pricing screen will show the pricing of the claim based on the date of service for the member.
At this time, you are unable to see a fee schedule that is no longer active.
If the member is an EHB member (i.e. purchased the plan through the Marketplace) , there is a possibility that we may have to hold the claim if the member is not current with paying the premium. Each member has a ninety day grace period. If the premium hasn't been paid after the grace period, we will deny the claim. At that point, the member will be fully responsible for the services rendered. If the member is not current on their premium, we will mail a letter to you advising of this upon claim submission.
Our turnaround time for claims that are submitted with all of the necessary information is thirty days. Please review our claims attachment guidelines to assist in timely payment of claims. Click here for more information.
Most of our plans have orthodontic services paid in three parts: banding, debanding and the monthly automatic payment until the ortho coverage has been satisfied. The DHMO and Direct Compensation plans reimburse differently however. The most accurate way to obtain how the specific plan pays is by contacting our customer service team at 800-445-9090.
Yes. We administer Coordination of Benefits (COB) according to the birthday rule. If both parties have the same birthday, we will determine which plan is the one that has covered the patient longer.
Claims are subject to Coordination of Benefits (COB) when we are notified that other insurance exists. Previously paid amounts are applied against the allowable amount when we are the secondary insurance carrier.
We support Coordination of Benefits (COB) and identify potential COB claim situations the following ways:
Other insurance indicated on the claim form or at the time of enrollment.
Spouse employment indicated on the claim form or at the time of enrollment.
Once the potential COB situation has been identified, the claims system is programmed to automatically alert processors each time a subsequent claim is received and processed. The system does contain online edits for prior experience by the claimant. The processor then determines if we are the primary or secondary carrier. If we are the primary carrier, the claim is paid, and the member would submit the claim to the secondary carrier with a copy of the EOB showing the primary payment. If we are the secondary carrier, the customer is notified. We will then wait for the primary carrier’s payment before we adjudicate the claim as the secondary carrier.
COB savings are calculated by taking the difference between the amount paid as the secondary carrier and the amount that would have been paid as the primary carrier.
COB recovery is done in-house. The notation of other coverage is maintained indefinitely until a change is positively noted on a subsequent claim and is associated with subscriber (and all members of the family).
Coordination of Benefits savings is maintained within the claims system and can be accumulated both on a calendar year and year-to-date-basis.
We do ask that your office notifies us whenever there are changes to the practice. Common reasons can be, but not limited to: address changes, Tax ID changes, a dentist leaving the practice, or a new dentist joining the practice.
As a participating provider, you may not balance bill the member if the service is covered. However, there may be times where the services that may not be covered on the member's plan. For example, a member may have met his annual limit or has met the frequency limitation. The member is responsible for your full fee if the services are not covered provided this information has been disclosed to the patient prior to services being rendered.
Absolutely! You can click Join the Network and fill out the appropriate paperwork. Once the paperwork is received, a recruiter will contact you and discuss how the plan is reimbursed and next steps.
We ask that you satisfy a year on the contract before requesting any changes.
We require 90 days written notice to terminate the contract. Once the notification has been received, a recruiter will reach out to you to discuss the next steps. The letter can be faxed to 877-572-3043.
If you are one of our valued leased network providers, we want to remind you that you have access to the following resources on this website (uhcdental.com):
- Eligibility and Benefits
- Claim Status
- Clinical Guidelines
- Submit Claims
- Set Up Electronic Claim Payments
- Fee Schedule Requests
Important: If the request pertains to the following, you are required to contact the leased network in which you participate:
- Fee/Contractual Negotiations
- Contract Requests
- Demographic Updates (e.g. name, address, phone, tax information, etc.)
- Termination/Opt Out Requests
While we would appreciate your dentist to join all available networks in your area, it is not required.
There is no charge or membership fee to join the network.
Our credentialing process takes approximately 90 days to complete.
We do! On the DBP application, there is a section called CAQH ID. This is where you would indicate your CAQH ID number.
In most cases, once you have submitted the documents from the Join the Network page, your local recruiter will be in contact with you. The recruiter will discuss what was received as well as the contracted rates for the plans in your area. At that point, the recruiter will send a contract to you so that the owner of the practice may sign.
If the contract has not been returned, or if any part of the application is incomplete, we will not be able to move forward with credentialing the dentist until that information is received. In turn, this will delay us in activiating the dentist as in network.