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
pre-populated - 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 Information for 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 Information for a list of addresses):
- Blue Shield of California
- HealthNet
- Medicare*
- Solstice Benefits
- UMR
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
- Appeals
* 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 Information to 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:
PTE/Prior Authorizations
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.
- Q1 2024 AR Prior Utilization Review Statistics
- Q4 2023 AR Prior Utilization Review Statistics
- Q3 2023 AR Prior Utilization Review Statistics
- Q2 2023 AR Prior Utilization Review Statistics
- Q1 2023 AR Prior Utilization Review Statistics
- Q4 2022 AR Prior Utilization Review Statistics
- Q3 2022 AR Prior Utilization Review Statistics
- Q2 2022 AR Prior Utilization Review Statistics
- Q1 2022 AR Prior Utilization Review Statistics
- Q4 2021 AR Prior Utilization Review Statistics
- Q3 2021 AR Prior Utilization Review Statistics
- Q2 2021 AR Prior Utilization Review Statistics
- Q1 2021 AR Prior Utilization Review Statistics
- Q4 2020 AR Prior Utilization Review Statistics
- Q3 2020 AR Prior Utilization Review Statistics
- Q2 2020 AR Prior Utilization Review Statistics
- Q1 2020 AR Prior Utilization Review Statistics
- Q4 2019 AR Prior Utilization Review Statistics
- Q3 2019 AR Prior Utilization Review Statistics
- Q2 2019 AR Prior Utilization Review Statistics
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 enrollmentwebpage. 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.
