United Healthcare requests medical records for most of the claims. After our deep analysis we found that if the total claim charge amount is more than $1,300 UHC is requesting medical records. We tried two claims for different patients with the same procedure but one with a total charge amount above $1,300 and other less than $1,300. United Healthcare requested a medical record for the claim with above $1,300 and paid the claim below $1,300 according to the contract. Rather than doing further analysis if the UHC medical records requests are reasonable we managed to split the claims for the same DOS so that the total charged amount is less than $1,300. Hundred percent of claims are paid in first submission without medical record request. Show Medical Billing ServiceApple Billing and Credentialing provides comprehensive medical billing for all healthcare providers
 Do you need copies of your medical records for tax purposes, school, or other purposes?
Please fill out and return the form below along with a copy of your ID in one of the following ways: 1. Mail Mail the completed form to our Administration Office (Attn: Medical Records Department): 3875 W. Beechwood Ave. Fresno, CA 93722 2. Fax Fax the completed form to our Medical Records Department at 1-855-771-5224 3.
Drop-Off Drop off the completed form at any of our health centers. Please note: The completed form must be submitted with a copy of the ID of the patient or patient's representative (whoever signed the form). Authorization for release of
Information - English Autorización para Liberación de Información- Spanish
Medicare Advantage (Part C) Coverage Decisions, Appeals and GrievancesThe following procedures for appeals and grievances must be followed by your Medicare Advantage health plan in identifying, tracking, resolving and reporting all activity related to an appeal or grievance. The process for coverage decisions and making appeals deals with problems related to your benefits and coverage for a medical item/service and Part B prescription drugs, including problems related to payment. This is the process you use for issues such as whether something is covered or not and the way in which something is covered. Asking for coverage decisionsA coverage decision is a decision given in writing that we make about your benefits and coverage or about the amount we will pay for your medical items/services or Part B drugs. We and/or your doctor make a coverage decision for you whenever you go to a doctor for medical care. You can also contact the plan and ask for a coverage decision. For example, if you want to know if we will cover a medical item/service or Part B drug before you receive it, you can ask us to make a coverage decision for you. Timing of the organization decision depends on the type of request. Type of RequestTiming of Organization DecisionStandard Part C Pre-Service or Benefit Within 14 calendar days after receipt of your request Standard Part B Drug Request Within 72 hours after receipt of your request Expedited Request for Part C Benefit – if you or your doctor believe your health will be harmed by waiting 14 calendar days Within 72 hours after receipt of your request Expedited Request for Part B Drug – if you or your doctor believe your health will be harmed by waiting 72 hours Within 24 hours after receipt of your request
Within 30-60 calendar days, if not earlier, after receipt of your request Submit a written request for a coverage decision to: UnitedHealthcare Customer Service Department PO Box 29675 Hot Springs AR, 71903-9675 PhoneYou may also ask for a coverage decision by calling the member services number on the back of your ID card or contacting UnitedHealthcare. FaxFax a written request for a coverage decision to 1-888-517-7113. Fax an expedited request to 1-866-373-1081 along with a note that your request should be expedited. We are making a coverage decision for you whenever we decide what is covered for you and how much we pay. In some cases, we will decide a service or drug is not covered or is no longer covered by Medicare for you. If you disagree with this coverage decision, you can make an appeal. Who can file an appealAn appeal may be filed by any of the following:
You may appoint an individual to act as your representative to file the appeal for you by following the steps below:
What an appeal isAn appeal is a type of complaint you make regarding an item/service or Part B drug:
When appeals can be filedYou may file an appeal within sixty (60) calendar days of the date of the notice of the initial organization determination. For example, you may file an appeal for any of the following reasons:
Note: The sixty (60) day limit may be extended for good cause. Include in your written request the reason why you could not file within the sixty (60) day timeframe. Mail a written request for an appeal to the UnitedHealthcare Appeals and Grievances Department at the address listed in your Evidence of Coverage. FaxPhoneWhy you file an appealYou may use the appeal procedure when you want a reconsideration of a decision (organization determination) that was made or the amount of payment your Medicare Advantage health plan paid
for an item/service or Part B drug. What to include with your appealYou should include:
You may send in supporting medical records, doctors' letters, or other
information that explains why your plan should provide the item/service or Part B drug. Call your doctor if you need this information to help you with your appeal. You may send in this information or present this information in person if you wish. What happens nextIf you appeal, UnitedHealthcare will review the decision. If any of the items/services or Part B drugs you requested are still denied after our review, Medicare will provide you with a new and impartial review of your case by a reviewer outside of our Medicare Advantage Organization or prescription drug plan. If you disagree with that decision, you will have further appeal rights. You will be notified of those appeal rights if this happens. Timing of the appeal answer depends on the type of request. Type of RequestTiming of Organization Decision
Standard Part C Pre-Service or Benefit Within 30 calendar days after receipt of your request Standard Part B Drug Request Within 7 calendar days after receipt of your request Expedited Part C Pre-Service or Benefit Within 72 hours after receipt of your request Expedited Part B Drug Request Within 72 hours after receipt of your request Within 60 calendar days after receipt of your request Fast decisions/expedited appealsYou have the right to request and receive expedited decisions affecting your medical treatment in "Time-Sensitive" situations. A Time-Sensitive situation is a situation where waiting for a decision to be made within the timeframe of the standard decision-making process could seriously jeopardize:
If your Medicare Advantage health plan or your Primary Care Provider decides, based on medical criteria that your situation is Time-Sensitive or if any physician calls or writes in support of your request for an expedited review, your Medicare Advantage health plan will issue a decision as fast as possible, but no later than seventy-two (72) hours—plus 14 calendar days, if an extension is taken—after receiving the request. For Part B drugs, your Medicare Advantage plan will provide a decision as fast as possible, but no later than 24 hours in Time-Sensitive situations with no allowable extensions. Who can file a grievanceA grievance may be filed by any of the following:
You may appoint an individual to act as your representative to file the grievance for you by following the steps below:
What a grievance isA grievance is a type of complaint you make if you have a complaint or problem that does not involve payment or services by your Medicare Advantage health plan or a Contracting Medical Provider. For example, you would file a grievance if:
When a grievance can be filedYou may file a grievance within sixty (60) calendar days of the date of the circumstance giving rise to the grievance. Expedited grievanceYou have the right to request an expedited grievance if you disagree with your Medicare Advantage health plan's decision to invoke an extension on your request for an organization determination or reconsideration, or your Medicare Advantage health plan's decision to process your expedited reconsideration as a standard request. In such cases, your Medicare Advantage health plan will respond to your grievance within twenty-four (24) hours of receipt. Where a grievance can be filedA grievance may be filed in writing or by contacting UnitedHealthcare Customer Service at the telephone number (or the TTY number for the hearing impaired) listed in the Summary of Benefits or Chapter Two of the Evidence of Coverage, 8 a.m. – 8 p.m., local time, 7 days a week. To file a grievance in writing, please complete the Medicare Plan Appeal & Grievance Form (PDF) (760.99 KB) and follow the instructions provided. Mail a written request for an appeal to the UnitedHealthcare Appeals and Grievances Department at the address listed in your Evidence of Coverage. FaxPhoneWhy you file a grievanceYou are encouraged to use the grievance procedure when you have any type of complaint (other than an appeal) with your Medicare Advantage health plan or a Contracting Medical Provider, especially if such complaints result from misinformation, misunderstanding or lack of information. If you would like to provide feedback regarding your Medicare plan, you can contact Customer Service or you can provide feedback directly to Medicare through their Complaint Form about your Medicare health plan or prescription drug plan. |
United healthcare fax number for medical records
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