Major Commercial Payor

UnitedHealthcare / Optum Provider Guide

Complete credentialing, billing, and authorization guide for UHC, Optum, and affiliated plans

Avg. Credentialing

90-120 Days

Timely Filing

365 Days

Appeal Window

180 Days

Portal

Link Health

UnitedHealthcare Overview

UnitedHealthcare is the largest health insurer in the United States. Optum is UHC's health services division that manages many authorization and billing functions. Understanding the relationship between UHC and Optum is critical for successful contracting and billing.

Key UHC/Optum Entities:

• UnitedHealthcare (commercial insurance)
• UnitedHealthcare Community Plan (Medicaid)
• OptumHealth (care delivery and management)
• Optum Behavioral Health (behavioral health services)
• OptumRx (pharmacy benefits)

Credentialing & Enrollment

UHC Credentialing Process

Application Steps

Complete CAQH profile (UHC uses CAQH for primary verification)
Submit application through Link Health provider portal
Complete supplemental UHC credentialing forms if required
Provide W-9, liability insurance, licenses, and certifications
Await credentialing committee approval (90-120 days)

Important Notes

• UHC credentialing typically takes 90-120 days
• Behavioral health providers may need separate Optum credentialing
• Keep CAQH updated within 120 days to avoid delays
• Some states require additional state-specific forms

Prior Authorization

Services Requiring Prior Auth

• Inpatient hospital admissions
• Advanced imaging (MRI, CT, PET scans)
• Outpatient surgery
• DME and orthotics
• Home health care
• Behavioral health (managed by Optum)
• Specialty medications

How to Submit

Online Portal

Link Health (fastest method)

Phone

1-866-633-2446

Fax

1-866-940-7328

Turnaround Time

Standard: 2-5 business days. Urgent: 24-72 hours

Optum Behavioral Health

Many UHC plans delegate behavioral health services to Optum Behavioral Health. This means separate credentialing and authorization processes.

For Behavioral Health Providers:

• Credential with both UHC and Optum Behavioral Health
• Use Optum's portal (LiveandWorkWell.com) for authorizations
• Different phone numbers and processes than medical UHC
• Contact: 1-888-281-6258 (Optum BH Provider Line)

Common UHC Denial Codes

CO-197: Authorization/precertification absent
Most Common

Why This Happens

UHC requires prior authorization for many services, especially imaging and procedures

Resolution

Submit retroactive authorization request with medical records. Success varies by service type and medical necessity.

CO-16: Claim/service lacks information

Why This Happens

Missing diagnosis codes, incorrect modifiers, or incomplete provider information

How to Fix

Review denial notice for specific missing elements. Resubmit with complete information.

CO-50: Non-covered services

Common Scenarios

Service not included in patient's benefit plan or deemed experimental/investigational

Next Steps

Verify benefits. If covered, appeal with plan documents. Otherwise, patient responsibility.

Important Contacts