Overview
UnitedHealthcare pays clean electronic claims within 15 business days for in-network providers. Paper claims take 30 business days. These timelines apply to commercial plans; Medicare Advantage follows CMS rules requiring payment within 30 days of receipt.
Key Requirements
- Clean electronic claims: payment within 15 business days of receipt.
- Paper claims: payment within 30 business days.
- Medicare Advantage plans: 30-day payment window per CMS requirements.
- EFT enrollment through Optum Pay speeds deposits by 2-3 days versus paper checks.
- Incomplete claims restart the clock once corrected information is received.
Timeline
Day 1: Claim received and logged. Days 2-5: Automated adjudication for clean claims. Days 6-15: Payment processed for electronic claims. Days 16-30: Paper claim processing window. If claim pends for review, add 10-15 business days to the standard timeline.
Common Denials
| CARC Code | Reason | Primary Cause | Fix |
|---|---|---|---|
| CO-29 | Timely filing exceeded | Claim filed after 90-day INN / 180-day OON deadline | Submit within 45 days for safety margin |
| CO-4 | Procedure code inconsistent with modifier | Modifier mismatch on claim line | Verify modifier before submission |
| CO-16 | Claim differs from payer records | Authorization data mismatch | Cross-check auth number on claim |
Appeals
If payment is delayed past 30 days, contact UHC Provider Services at 1-877-842-3210. For payment disputes, submit a reconsideration within 60 days of the remittance advice date. Include the claim number, expected payment amount, and contract reference.
FAQ
How do I check UnitedHealthcare claim payment status?
Log into the UHC provider portal at uhcprovider.com. Navigate to Claims, then Claim Status. Search by patient ID or claim number. Status updates within 24 hours of adjudication.
What if UnitedHealthcare payment is less than expected?
Compare the EOB line items against your contract fee schedule. If underpaid, file a payment dispute within 60 days of the remittance date. Include the contract rate and the EOB showing the discrepancy.
Does UnitedHealthcare offer EFT payments?
Yes. Enroll through Optum Pay at optumpay.com. EFT deposits arrive 2-3 days faster than paper checks and include electronic remittance advice (ERA).
Prevent These Denials
Altair tracks claim payment timelines across all payers and flags delays before they become write-offs.