If you decide to appeal our decision to deny authorization for a service, you should tell your treating provider so the provider can help you with the information you need to present your case. How long does it take for UHC to process a claim?Ī decision on a request for prior authorization for medical services will typically be made within 72 hours of us receiving the request for urgent cases or 15 days for non-urgent cases. To obtain an aggregate number of the plan’s grievances, appeals and exceptions please contact UnitedHealthcare. You must file your appeal within 60 days from the date on the letter you receive. Thus, if you miss the deadline, you can neither bill the patient for the visit nor appeal to the payer. If you look at the terms of any of your insurance company contracts, you’ll almost certainly see a clause indicating that the payer isn’t responsible for any claims received outside of its timely filing limit. What usually happens when you miss the timely filing deadline? For example, if a payer has a 90-day timely filing requirement, that means you need to submit the claim within 90 days of the date of service. Timely filing is when you file a claim within a payer-determined time limit. What are the situations for timely filing? Letter from another insurance carrier or employer group indicating no coverage for the patient on the date of service of the claim. Other valid proof of timely filing documentationĪnother insurance carrier’s explanation benefits. What is considered proof of timely filing? The 2-step process, as outlined below, allows for a total of 12 months for timely submission for both steps (Step 1: Reconsideration and Step 2: Appeals). You must submit both your reconsideration and appeal to us within 12 months (or as required by law or your Agreement), from the date of the EOB or PRA.
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