UnitedHealthcare® is an operating division of UnitedHealth Group, the largest single health carrier in the U.S.
We are committed to improving the health care system. 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.
The UnitedHealthcare nationwide network includes nearly 768,500 physicians and health care professionals, more than 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 5 years. These investments led to changes that are improving the way care is delivered and administered across the entire industry.
What brands are under the UnitedHealthcare umbrella? You may see a variety of names on a member’s card. Our dental provider network is most popularly known as Dental Benefit Providers (DBP). You could see the following brands being used in conjunction with the DBP logo. The brands include, but are not limited to:
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 members.
What is the phone number for Customer Service? You can reach our Customer Service team at 800-445-9090 or Provider Services at 800‑822‑5353. To avoid potential wait times, call Wednesday–Friday, 7–10 a.m. or 2–10 p.m. CT.
What are your hours of operation? Our Customer Service team is available Monday–Friday, 7 a.m.–10 p.m. CT.
What types of plans does UnitedHealthcare offer? UnitedHealthcare® offers an array of insurance plans, including ones with dental coverage, employer-based plans, individual plans and plans that cover the Medicare and Medicaid demographics. While most are traditional PPO plans, we also offer DHMO, direct compensation, discount and in-network only plans in select areas. For more information, please reach out to our Customer Service team at 800-445-9090. To avoid potential wait times, call Wednesday–Friday, 7–10 a.m. or 2–10 p.m. CT.
Does UnitedHealthcare offer dental plans in my area? We offer dental plans throughout the U.S. A series of our plans provide coverage nationwide, while some are specific to geographical areas. For more information, please reach out to our Customer Service team at 800‑445‑9090 or Provider Services at 800‑822‑5353. To avoid potential wait times, call Wednesday–Friday,
7–10 a.m. or 2–10 p.m. CT.
What are Essential Health Benefit plans? Essential Health Benefit (EHB) plans were created from the Affordable Care Act (ACA) to include health care coverage for 10 categories, including dental care for children (generally up to age 19) and optional dental care for adults. EHB plans are offered through Marketplace and can also be embedded in small group medical plans.
ACA requires specific EHB plans to be covered under health plan offerings for individuals and small groups of 50 or fewer employees.* The plan designs vary by state and most coordinate with traditional employed-based dental coverage beyond the benefits provided through medical plans. If you have additional questions about EHB plans, please reach out to our Customer Service team at 800-445-9090. To avoid potential wait times, call Wednesday–Friday, 7–10 a.m. or 2–10 p.m. CT.
*Requirements vary by state and may include up to 100 employees.
What is a discount plan? Discount plans are not traditional plans, and members who purchase these plans are not fully insured. Instead of filing a claim, a member pays the provider directly based on a discounted rate.
Where can I find information on Medicare? Go to UHCdental.com for information on Medicare dental coverage and to access quick reference guides, newsletters and more.
How can I check member eligibility for my patient? You can use the following methods to check a member’s eligibility for UnitedHealthcare® plan benefits:
UHCdental.com provider portal
Sign in to the provider portal and access the dashboard to search for an individual or family by name, date of birth or subscriber ID
Electronic data interchange (EDI)
You can inquire about a member’s health care eligibility and benefits using transaction codes in EDI
EDI is set up through your practice management system and can be used for batch transactions. To learn about the benefits of EDI, how to set it up in your system and get troubleshooting assistance, visit the EDI information page. or review this quick reference guide.
Where on the portal can I find if a member is eligible for benefits? You can review the Eligibility Summary page for information. If a member is eligible for benefits, a “Y” will display next to “eligible” in the center box on the page. An “Out of Network” banner message will display if the member is out of network for the provider.
Go to UHCdentalproviders.com and sign in to verify eligibility for Dual Special Needs Plans and Medicaid members.
I rendered services to a member whose plan showed they were eligible for in-network benefits. After submitting the claim, I received notice that the member is not eligible. What can I do? The information obtained during the benefit breakdown prior to services rendered is not a guarantee of benefits. It is important to provide appropriate financial disclosures to your patient with this information before the treatment is applied. If the services are not covered due to termination of benefits, your patient is responsible for the full amount of the services rendered.
How do I check claim status on UHCdental.com? After signing in to UHCdental.com, you’ll be brought to the Dashboard page where you’ll find a summary of claims submitted within the past 30 days. Click “More” to find older claims. You can also search for claims by date or member information.
How far back can I check a claim? You can review claims history up to 2 years from the current date.
Can I view a claim if the patient was seen by a provider not affiliated with my office?
We cannot show claims that were not paid to your office due to privacy restrictions. To determine a member’s out-of-pocket costs, you can check if a service was previously rendered. First, verify the member’s eligibility on the Eligibility Search page. You can find it under Search in the navigational bar. Next, go to the Benefit Details page to view the benefit breakdown.
What is the UnitedHealthcare Payer ID? The Payer ID for UnitedHealthcare commercial plans is 52133. If your patient is a Medicaid member, the Payer ID will be different. Contact our Provider Services team at 800-822-5353 for more information.
Can I submit claims online? Yes. You may submit all claims for commercial and Medicare Advantage plans online at UHCdental.com.* After signing in, go to:
Treatment Plans on the top navigational bar for a list of the provider’s treatment plans within the last 30 days
Claim Information to submit an online claim or pre-treatment estimate with your provider information
Recent Treatment Plans table for a display of the provider’s treatment plans within the last 30 days
Treatment Plan Calculator to create, view or edit a treatment plan for a member you have selected in the Eligibility Search section. Treatment plans are valid for 30 days.
You can also go to Claim Information on the pre-sign in page and use the Dental Claim tool. Note, the system will not pre-populate the fields with member information using this tool.
* Use UHCdentalproviders.com to submit claims and verify eligibility for members of Medicaid and Dual Special Needs Plans.
What is the address where I can mail claims? Go to Claim Informationfor a list of addresses of where you can mail paper claims.
Can I fax a claim? We accept claims by fax at 248-733-6372, apart from those indicated below.
Claims for these entities are not accepted by fax and must be submitted online at UHCdental.com or by mail (see Claim Informationfor a list of addresses):
Blue Shield of California
We do not accept these types of correspondence by fax:
Claims with X-rays and other attachments
Requests for check reissues
Requests for claims adjustments or reconsideration
* Use UHCdentalproviders.com to submit claims and verify eligibility for members of Medicaid and Dual Special Needs Plans.
What documentation should I send when submitting a claim? We may require additional information to properly adjudicate the claim, depending on the services rendered. Go to Claim Informationto learn about the requirements.
Do claims go through a dental review process? Yes. Depending on the services performed, a dental consultant will be selected from a team of dentists to review the claim. The consultant will base all decisions on criteria specific to the American Dental Association (ADA) code. Go to the UnitedHealthcare Dental Utilization Review Guideline for more information about the criteria.
What is the turnaround time for processing claims?
Claims that are submitted with all the necessary information will be processed in 30 days. Please review our guidelines for claims attachments to assist in timely payment of claims.
How do I submit pre-treatment estimates (PTEs) for review? You can submit PTEs, or prior authorizations, electronically on UHCdental.com or by paper.
For members with PPO and Medicare Advantage plans, you can submit a PTE online by signing in to UHCdental.com and identify the member in the Eligibility Search section. Create a treatment plan for the member using the Treatment Plan Calculator and submit a PTE electronically for each treatment plan. Please refer to the Resources tab on the top navigational bar for more information about the Treatment Plan Calculator.
For members with Dental Health Maintenance Organization (DHMO) or Direct Compensation (DC) plans, you can submit a PTE online by going to Claim Information on the top navigational bar and clicking Start.
Mail paper PTEs to:
P.O. Box 30552
Salt Lake City, UT 84130-0552
Additional information may be required. PTEs are valid for 90 days from the decision date.
How do I submit orthodontic claims? Most of our plans for orthodontic services are paid in 3 parts — upon banding, at de-banding and monthly by automatic payment until the orthodontic coverage is satisfied. The DHMO and DC plans reimburse differently. Reach out to our Customer Service team at 800-445-9090 for information on how specific plans pay.
I submitted a claim for services rendered and received a letter stating my patient has not paid the premium for their health plan. How will the claim be processed? If the patient is an Essential Health Benefit (EHB) member (i.e., they purchased the plan through Marketplace) and is not current on their premium payment, we may hold the claim. We will notify you of this by mail when the claim is submitted. If the premium is not paid after a 90-day grace period, we will deny the claim. At that point, the member is fully responsible for the services rendered.
Which states require disclosure of prior authorization statistics for pre-service review? Only Arkansas requires prior authorization reporting. The following links comply with the state’s regulatory requirement, which mandates disclosure of information for services that require pre-service review.
Does UnitedHealthcare have a specialty referral process for DHMO and DC plans? Yes. Many DHMO and DC plans have a specialty referral process. The process may differ depending on the plan. Please contact our Provider Services team at 800-822-5353 for more information.
How can I submit supporting X-rays online? You can upload supporting documents online to DentalXChange, Tesia and FastAttach from NEA, powered by Vyne.
Can I enroll for direct deposit? Yes. You can enroll your organization for direct deposit of claim payments. To learn about electronic payment solutions, review our Electronic payment enrollment webpage. To enroll in free ACH, visit UHCdental.epayment.center/register or call 855-774-4392. For other electronic payment options, such as Virtual Credit Card or ACH+, contact Zelis at 877-828-8770.
What is the difference between fee schedule and the Treatment Plan Cost Calculator? The fee schedule page on UHCdental.com shows the current fee schedule in real time. The Treatment Plan Cost Calculator shows the pricing of the claim as of the member’s date of service.
Can I view a previous fee schedule? No. You are unable to view inactive fee schedules.
Do you support coordination of benefits (COB)? What is the process? Yes. We follow this process for COB claims:
Potential claims situations are identified when:
Other insurance is indicated on the claim form or at the time of enrollment
Spouse employment is indicated on the claim form or at the time of enrollment
After the potential situation has been identified, processors are automatically alerted each time a claim is received and processed
The system contains online edits for prior experience by the claimant
The processor determines if UnitedHealthcare is the primary or secondary carrier
If UnitedHealthcare is the primary carrier, we pay the claim and the member submits the claim to the secondary carrier with a copy of the explanation of benefits showing the primary payment
If UnitedHealthcare is the secondary carrier, the member is notified, and we adjudicate the claim after the primary carrier has made their payment. In this scenario, the savings are calculated as the difference between the amount paid as the secondary carrier and the amount that would have been paid as the primary carrier.
Recovery for COB is done in-house. The identification of other coverage is maintained indefinitely until a change is noted on a subsequent claim and is associated with subscriber (and all members of the family).
When are claims subject to COB? Claims are subject to COB when we are notified that other insurance exists. If we are the secondary insurance carrier, previously paid amounts are applied against the allowable amount.
Do you administer COB according to the birthday rule? Yes. We apply the birthday rule when administering COB. If both parties have the same birthday, we determine which plan has covered the patients longer.
Does your system maintain the COB premium savings on a year-to-date or calendar-year basis? The savings from COB claims are maintained within the claims system and can be accumulated both on a
year-to-date and calendar-year basis.
The American Dental Association approved D-Codes for vaccines. Can I submit claims for those? Yes. You can submit them through the member’s medical plan as an out-of-network provider. Download the COVID-19 Vaccine Claim Submission Information for details.
Am I required to notify UnitedHealthcare of any changes to my practice? Yes. The Centers for Medicare & Medicaid Services (CMS) mandates health care providers maintain accurate online directories. To help meet this requirement, you must review your directory every 90 days and notify us of changes, including:
Do I need to remain in network for a specific amount of time before terminating my contract? Yes. You must fulfill a 1-year commitment on your contract before requesting changes.
What is your termination policy? You must provide written notice 90 days prior to terminating your contract. Once the notification has been received, a network contractor will reach out to you to discuss the next steps. Submit termination letters by:
Can I balance bill my member? You may not balance bill the member if the services rendered are covered on the member’s plan. There may be instances when the services are not covered. For example, a member may have reached the annual and/or frequency limit. In these instances, the member is responsible for your full fee if the services are not covered in the plan — provided this information has been disclosed to the patient prior to services being rendered.
How do I become a participating network provider so new members can access my practice? You need to complete the application process to participate in our network.
Go to UHCdental.com
Select Join our network and request a provider packet
Complete and submit the required paperwork
Once your paperwork is received, a network contractor will contact you to discuss how the plan is reimbursed and the next steps in the process.
Is there a cost to join the network? No. There is no charge or membership fee to join the network.
I submitted the required documents. What are the next steps in the application process? Once you submit the documents, your local network contractor will reach out to you to discuss the documents received and the contracted rates for plans in your area. Your network contractor will send a contract for the owner of the tax identification number to sign and complete the application process.
We cannot move forward with the credentialing process if the contract is not returned, or the application is incomplete. Please promptly return the information to avoid a delay activating the dentist in our network.
How long will it take to become a participating provider? Our credentialing process takes approximately 90 days to complete.
Am I required to join every network UnitedHealthcare offers in my area? No. You have the option but are not required to join all available networks in your area.
Does Dental Benefit Providers participate in CAQH? Yes. We’re a participating organization that uses the American Dental Association® credentialing service, powered by CAQH ProView®. Get more information on how to simplify your credentialing process using this online resource.