TAT
What is the TAT for claim processing?
30 Business Days (Other Plans) and 45 Calendar Days (SIA Group) from CBDQ Date.
What are the payment methods for claims?
Providers can be paid through EFT, Virtual Payment or Paper Check.
What is the fax number for claim submission?
844-832-5925
What are the two decisions for an appeal?
An appeal can either be upheld or overturned.
What is an FCN and what does it mean?
FCN means Financial Control Number and is a unique identifier assigned to the overpayment transaction.
What is the TAT for CSR escalations?
20 Business Days
When can we provide a check number?
When the payment has been released (Payment Date in Admin and Issued Date in CPS are different).
What is the mailing address for claim submission?
P.O. Box 30526 Salt Lake City, UT 84130-0526
Can a provider appeal a pre-service denial?
No - Pre-authorization denials cannot be appealed only Post-service denials can be appealed
What address can refund checks be sent to?
P.O. Box 8033 Wausau, WI 54402 In attention to: Adjustment team
What is the TAT when a claim is in Returned status on CART?
5 Business Days
Where do we submit escalations for claims that have a payment on hold for more than 15 Business Days?
Submit a CSR through CART
Where can we look for a claim that is not found in CART, Admin, CPS, or Web Claims?
GJAH
What is the timely filling limit for submitting a claim appeal?
INN Providers: 365 Days from Denial Date
OON Providers: 180 Days from Denial Date
How many days does a provider have to submit the overpayment by check?
30 days
What is the TAT for an Eligibility Update Tickler?
2 Business Days
What do we advise to a provider when a payment is no longer on the Hold Report?
Please allow 5-7 business days for payment to cycle.
Julian Date Calendar:
- First 2 Digits are the year we received the claim
- Digits 3-5 are the Day of the year the claim was received.
What is the Appeals fax number?
877-405-2069
What happens if a provider does not submit an overpayment?
CPS will auto recoup the payment on another claim.
What is the TAT for keying claims?
5 Business Days
What do we do when a check number is on the Hold Report for less than 15 business days?
Advise the provider to allow 30 business days for the payment to be received in their system.
Claims found only in OnBase but NOT in CART, ADMIN, CPS, WEBCLAIMS, GJAH are escalated to _________. (after 5BDs)
UHA_Admin@uhcglobal.com
What scenarios are valid RUSH SIU review requests and where do we escalate to when we see a RUSH SIU Issue?
Threat of media attention, High risk customer status (Red status customer), Member is being sent to collections, Member involved in active litigation, Review has been in SIU > 30 days.
If RUSH issue exists:
Send an e-mail to USNAS_Escalations@uhcglobal.com or to leaders
What does IDENTIFICATION OF OUTSTNDING mean on the CPS Tracking Tab?
Overpayment Identified. An adjustment was done and the system recognizes an overpayment exists.