Submit Medical Claims Electronically
We are committed to the timely1 and accurate processing of your claims, and encourage claim submission through electronic data interchange (EDI). Now there are two simple and secure ways to submit medical claims electronically. You may connect either directly to UHA or through the Post-N-TrackTM online service.
Both methods are quick to set up and providers who submit claims electronically will enjoy:
- Faster processing and reimbursement of claims2
- Proof of timely submission through electronic acceptance reports
- Reduced number of lost claims
- Reduced costs associated with labor, paper, and postage for claims
Complete the UHA Trading Partner Agreement to submit claims electronically. Read below to learn more about each method of electronic submission. If you are unsure of which process is right for you, please contact Provider Services for assistance.
Send through Post-N-TrackTM online service
The Post-N-TrackTM service is a direct Internet connection to UHA. It's secure, easy-to-use and provided at no cost3 to all health care providers. Claims are delivered immediately via the Web, with quick confirmation and claim tracking.
- Easy to install and simple to use
- Installation takes just minutes on a standard desktop PC with Web connection
- Compatible with your existing submission process
- Eliminates issues with clearinghouses, and accelerates transactions with payers linked to Post-N-TrackTM
- Built-in claim tracking provides an immediate receipt for every claim you send
- Online reports for claims sent, financial totals, errors and payer responses
- And more! Get more information and details on the Post-N-TrackTM website...
Enroll now and get started with Post-N-TrackTM.
Send directly to UHA
You must be able to generate an 837 claim transaction file to send directly to UHA. Download the UHA Trading Partner Manual as your guide to set up your connection. Then, complete and submit the following forms to Information Services:
- EDI 837P Professional Claim Registration - required if submitting professional electronic claims
- EDI 837I Institutional Claim Registration - required if submitting institutional electronic claims
- EDI 835 Remittance Advice Request - optional, complete and return to UHA only if requesting to receive HIPAA EDI 835 Remittance Advice transaction files
- Medical claims must be filed within one year of the date of service to ensure the claim is payable. This requirement also applies when UHA is your patient's secondary insurance carrier. An exception may be made to the one-year filing time limitation when UHA is secondary to Medicare. Timely filing of claims is the provider's responsibility. You may not collect payment from the member for any covered services after the one-year claims submission deadline has expired.
- A clean claim means no missing data fields and HIPAA compliant transaction set.
- Providers are responsible for any expense required to enable connectivity to the Internet including, but not limited to, a computer and Internet connection fee.
Avoiding Returned Claims
Reduce the time it takes to process your claim and avoid a returned claim by completely and correctly filling in the claim form. The following items, if missing or incorrect, will delay processing of your claim or even result in a request for re-submission:
- Subscriber's name
- Subscriber's member ID number (11-digits)
- Patient's name and date of birth
- Date of service
- UHA group number (4-digits)
- Name of referring physician for claims from laboratories, radiologists, and consultants
- Date, place, and cause of injury
- Descriptive diagnosis and ICD-9 code
- Descriptive procedures and CPT code
- Charges
- Provider's billing name and address
- Provider or agent's signature
- Supportive data for modifiers, e.g., after-hours modifier - claim should have time listed
- Provider Identification Number (PIN)
- Federal tax ID number
Requesting Reconsideration of a Claim
If you believe a claim should not have been denied, or disagree with the amount of the payment, you may request that we review the claim1. We will review your request and get back to you within two business days. We will then provide you with an estimate of the time it will take to resolve your issue. We may request additional written information from you (e.g., additional diagnostic information, emergency notes or an operative report) to aid in the review process.
If you need to request reconsideration of a claim, please complete a Claims Reconsideration Request.
Upon review completion, one of two things may happen:
- We will reprocess the claim (and send you a new Remittance Advice Summary), or
- We will inform you in writing why we believe our original determination was correct. If the matter is not resolved to your satisfaction, you may appeal our decision to our Appeals Committee.
For more information on how to file an appeal or for general claims information, please refer to our Provider Handbook.
- Requests for review must be made within one year of the date the claim was paid or denied.
