We hope this helps you “ Get Paid Right the First Time ”. It doesn’t take long to check and submitting the form in a timely manner will ensure payment and eliminate the hassle of having to file an appeal. You can either call Optum Health Care Solutions at 1-88 or log onto and use the “quick group check” utility located in the "Tools and Resources" section. There are two options you can use to determine if the patient has a plan with benefits that require a Patient Summary Form. If the claim is denied, an appeal may be filed but payment will only be received from UHC if you provide an “acceptable” explanation leaving the chances of payment solely up to UHC’s discretion. The Patient Summary Form must be submitted via fax or on-line and the timely filing deadline for providing this documentation is 10 days from the date of service.įailure to timely submit the Patient Summary Form will result in loss of payment. The Patient Summary Form was created for certain UHC plans to provide the insurance company with an explanation for the patient’s visit and confirm the need for treatment. BlueCross BlueShield generally has a 365-day timely filing limit. UnitedHealthcare has a 90-day timely filing limit. Medicare has a 365-day timely filing limit.
Medicaid has a 95-day timely filing limit. Here at Account Matters we are hearing first hand from clinics who are being denied payment because they are failing to submit this mandatory paperwork with UHC when required. Here are some of the most common payers and their timely filing deadlines. There is growing proof that medical providers are not up to date on why and when they should submit the mandatory Optum/United Healthcare Patient Summary Form.
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