UnitedHealthcare is discontinuing the mailing of paper remittance advice, or proof that an invoice has been paid, to network healthcare providers and institutions in 12 Western states. The adjustment will take effect on November 5th. Providers will receive remittance guidance electronically rather than on paper. Most UnitedHealthcare plans are affected by the move, with minor exceptions for regional and Medicare plans, as well as mental health insurance.
- New adjustments: The adjustment is in keeping with UnitedHealthcare’s ongoing efforts to transition payment processes from paper to digital. UnitedHealthcare announced in August 2020 that it would phase out paper checks in favor of electronic payments.
- Benefits: Some health care benefit plans administered or insured by affiliates of UnitedHealth Group Incorporated provide out-of-network benefits for United’s members. Providers will be able to view their remittance advice electronically through UnitedHealthcare’s provider portal, Optum Pay, and electronic data interchange.
- Provisions: When reviewing a claim for payment for a service provided by an out-of-network provider, United follows the member’s benefit plan. The member’s benefit plan will explain which services are covered out-of-network. The member’s benefit plan will also explain how an out-of-network claim should be paid.
- Reimbursement: Reimbursement for out-of-network providers are subject to United’s reimbursement policies. Application of our reimbursement policies typically results in a decrease to the allowed amount. United’s reimbursement policies are generally based on national reimbursement rules and determinations, along with state government program reimbursement policies and requirements.
- Expenses: By following the member’s out-of-network benefit plan, the maximum amount United will pay for a service, at times, will be less than the amount billed by the out-of-network provider. Members are responsible to pay their share of the out-of-network cost share. The provider may bill the member for difference, if any, between the amount allowed for the out-of-network service and the out-of-network provider’s billed charge.