what is complete claims?

Complete claims


For proper payment and application of deductibles and coinsurance, it is important to accurately code all diagnoses and services (according to national coding guidelines). It is particularly important to accurately code because a member’s level of coverage under his or her benefit plan may vary for different services. You must submit a claim for your services, regardless of whether you have collected the copayment, deductible or coinsurance from the member at the time of service.

To assist you in understanding how your claims will be paid, UnitedHealthcare’s Claim Estimator includes a feature called Professional Claim Bundling Logic which helps you determine allowable bundling logic and other claims processing edits for a variety of CPT (CPT is a registered trademark of the American Medical Association) and HCPCS procedure codes. Note: Only bundling logic and other claims processing edits are available under this option.

Pricing and payment calculations are not included.

Allow enough time for your claims to process before sending second submissions or tracers, then check their status online at UnitedHealthcareOnline.com. If you do need to submit second submissions or tracers, be sure to submit them electronically no sooner than forty-five (45) days after original submission.

Complete claims include the information listed under the Complete Claims Requirements section of this Guide.
We may require additional information for particular types of services, or based on particular circumstances or
state requirements.

If you have questions about submitting claims to us, please contact Customer Care at the phone number listed on the member’s health care ID card. For questions specific to electronic submission of claims, please review the information at UnitedHealthcareOnline.com  Claims and Payments  Electronic Claims Submission (EDI ). If you need additional information on EDI , contact the EDI Support Line at (800) 842-1109, Option 3.

Learn about the many tools available to help you prepare, submit and manage your UnitedHealthcare claims at UnitedHealthcareOnline.com including: Claim Estimator with bundling logic and Real-Time Adjudication. Training tools and resources including Frequently Asked Questions (FAQs), Quick References, Step-by-Step Help and Tutorials are available by clicking “Help” at the top of any page.

Note: At the time of publication of this Guide, the Claim Estimator is not available for Medicare
products.

To order 1500 HIC F (CMS-1500) and UB-04 (CMS-1450) forms, contact the U.S. Government Printing Office, call (202) 512-0455, or visit their Web site at cms.hhs.gov/CMSForms.

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