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UnitedHealthcare® is an operating division of UnitedHealth Group, the largest single health carrier in the U.S. We are committed to improving the health care system. As a recognized leader in the health and well-being industry, we strive to:
- Improve the quality and effectiveness of health care for all Americans
- Enhance access to health benefits
- Create products and services that make health care more affordable
- Use technology to make the health care system easier to navigate
Our family of companies delivers innovative products and services to approximately 70 million Americans.
The UnitedHealthcare nationwide network includes nearly 768,500 physicians and health care professionals, more than 80,000 dentists and 5,675 hospitals. Our pharmaceutical management programs provide more affordable access to drugs for 13 million people.
We're committed to the delivery of quality care and its continual improvement. In fact, UnitedHealth Group made significant investments in research and development, technology and business process improvements — nearly $3 billion in the past 5 years. These investments led to changes that are improving the way care is delivered and administered across the entire industry.
You may see a variety of names on a member’s card. Our dental provider network is most popularly known as Dental Benefit Providers (DBP). You could see the following brands being used in conjunction with the DBP logo. The brands include, but are not limited to:
- Dental Benefit Providers of California
- Dental Benefit Providers of Illinois
- National Pacific Dental
- Nevada Pacific Dental
- Pacific Union Dental
- AARP Medicare Complete
We also have a variety of private label plans that will not show the UnitedHealthcare logo. Please refer to the member's card for contact information for those particular members.
You can reach our Customer Service team at 800-445-9090 or Provider Services at 800-822-5353.
Our Customer Service team is available Monday–Friday, 7 a.m.–10 p.m. CT.
UnitedHealthcare® offers an array of insurance plans, including ones with dental coverage, employer-based plans, individual plans and plans that cover the Medicare and Medicaid demographics. While most are traditional PPO plans, we also offer DHMO, direct compensation, discount and in-network only plans in select areas. For more information, please reach out to our Customer Service team at 800-445-9090. To avoid potential wait times, call Wednesday–Friday between 7–10 a.m. or 2–10 p.m. CT.
We offer dental plans throughout the U.S. A series of our plans provide coverage nationwide, while some are specific to geographical areas. For more information, please reach out to our Customer Service team at 800-445-9090 or Provider Services at 800-822-5353. To avoid potential wait times, call Wednesday–Friday between 7–10 a.m. or 2–10 p.m. CT.
Essential Health Benefit (EHB) plans were created from the Affordable Care Act (ACA) to include health care coverage for 10 categories, including dental care for children (generally up to age 19) and optional dental care for adults. EHB plans are offered through Marketplace and can also be embedded in small group medical plans. ACA requires specific EHB plans to be covered under health plan offerings for individuals and small groups of 50 or fewer employees.* The plan designs vary by state and most coordinate with traditional employed-based dental coverage beyond the benefits provided through medical plans. If you have additional questions about EHB plans, please reach out to our Customer Service team at 800-445-9090. To avoid potential wait times, call Wednesday–Friday between 7–10 a.m. or 2–10 p.m. CT.
*Requirements vary by state and may include up to 100 employees.
Discount plans are not traditional plans, and members who purchase these plans are not fully insured. Instead of filing a claim, a member pays the provider directly based on a discounted rate.
Go to UHCdental.com for information on Medicare dental coverage and to access quick reference guides, newsletters and more.
You can use the following methods to check a member’s eligibility for UnitedHealthcare® plan benefits:
- UHCdental.com provider porta
- lSign in to the provider portal and access the dashboard to search for an individual or family by name, date of birth or subscriber ID
- Electronic Data Interchange (EDI)
- You can inquire about a member’s health care eligibility and benefits using transaction codes in EDI
- EDI is set up through your practice management system and can be used for batch transactions. To learn about the benefits of EDI, how to set it up in your system and get troubleshooting assistance, download this informational PDF
You can review the Eligibility Summary page for information. If a member is eligible for benefits, a “Y” will display next to “eligible” in the center box on the page. An “Out of Network” banner message will display if the member is out of network for the provider.
Go to UHCdentalproviders.com and sign in to verify eligibility for Dual Special Needs Plans and Medicaid members.
The information obtained during the benefit breakdown prior to services rendered is not a guarantee of benefits.
It is important to provide appropriate financial disclosures to your patient with this information before the treatment is applied. If the services are not covered due to termination of benefits, your patient is responsible for the full amount of the services rendered.
After signing in to UHCdental.com, you’ll be brought to the Dashboard page where you’ll find a summary of claims submitted within the past 30 days. Click “More” to find older claims. You can also search for claims by date or member information.
You can review claims history up to 2 years from the current date.
We cannot show claims that were not paid to your office due to privacy restrictions. To determine a member’s out-of-pocket costs, you can check if a service was previously rendered. First, verify the member’s eligibility on the Eligibility Search page. You can find it under Search in the navigational bar. Next, go to the Benefit Details page to view the benefit breakdown.
The Payer ID for UnitedHealthcare commercial plans is 52133. If your patient is a Medicaid member, the Payer ID will be different. Contact our Provider Services team at 800-822-5353 for more information.
Yes. You may submit all claims for commercial and Medicare Advantage plans online at UHCdental.com.* After signing in, go to:
- Treatment Plans on the top navigational bar for a list of the provider’s treatment plans within the last 30 days
- Claim Information to submit an online claim or pre-treatment estimate with your provider information pre-populated
- Recent Treatment Plans table for a display of the provider’s treatment plans within the last 30 days
- Treatment Plan Calculator to create, view or edit a treatment plan for a member you have selected in the Eligibility Search section. Treatment plans are valid for 30 days
You can also go to Claim Information on the pre-sign in page and use the Dental Claim tool. Note, the system will not pre-populate the fields with member information using this tool.
* Use UHCdentalproviders.com to submit claims and verify eligibility for members of Medicaid and Dual Special Needs Plans.
Go to Claim Information for a list of addresses of where you can mail paper claims.
- We accept claims by fax at 248-733-6372, apart from those indicated below.
- Blue Shield of California
- Solstice Benefits
We do not accept these types of corresondence by fax:
- Claims with X-rays and other attachments
- Requests for check reissues
- Requests for claims adjustments or reconsideration
* Use UHCdentalproviders.com to submit claims and verify eligibility for members of Medicaid and Dual Special Needs Plans.
We may require additional information to properly adjudicate the claim, depending on the services rendered. Go to Claim Information to learn about the requirements.
Yes. Depending on the services performed, a dental consultant will be selected from a team of dentists to review the claim. The consultant will base all decisions on criteria specific to the American Dental Association (ADA) code. Go to the UnitedHealthcare Dental Utilization Review Guideline for more information about the criteria.
Claims that are submitted with all the necessary information will be processed in 30 days. Please review our guidelines for claims attachments to assist in timely payment of claims.
You can submit PTEs, or prior authorizations, electronically on UHCdental.com or by paper.
- For members with PPO and Medicare Advantage plans, you can submit a PTE online by signing in to UHCdental.com and identify the member in the Eligibility Search section. Create a treatment plan for the member using the Treatment Plan Calculator and submit a PTE electronically for each treatment plan. Please refer to the Resources tab on the top navigational bar for more information about the Treatment Plan Calculator.
- For members with Dental Health Maintenance Organization (DHMO) or Direct Compensation (DC) plans, you can submit a PTE online by going to Claim Information on the top navigational bar and clicking "Start"
- Mail paper PTEs to:
P.O. Box 30552
Salt Lake City, UT 84130-0552
Additional information may be required. PTEs are valid for 90 days from the decision date
Most of our plans for orthodontic services are paid in 3 parts — upon banding, at de-banding and monthly by automatic payment until the orthodontic coverage is satisfied. The DHMO and DC plans reimburse differently. Reach out to our Customer Service team at 800-445-9090 for information on how specific plans pay.
If the patient is an Essential Health Benefit (EHB) member (i.e., they purchased the plan through Marketplace) and is not current on their premium payment, we may hold the claim. We will notify you of this by mail when the claim is submitted. If the premium is not paid after a 90-day grace period, we will deny the claim. At that point,
the member is fully responsible for the services rendered. See the Products FAQ for additional information on EHB plans.
Only Arkansas requires prior authorization reporting. The following links comply with the state’s regulatory requirement, which mandates disclosure of information for services that require pre-service review.
- Q1 2022 AR Prior Utilization Review Statistics
- Q4 2021 AR Prior Utilization Review Statistics
- Q3 2021 AR Prior Utilization Review Statistics
- Q2 2021 AR Prior Utilization Review Statistics
- Q1 2021 AR Prior Utilization Review Statistics
- Q4 2020 AR Prior Utilization Review Statistics
- Q3 2020 AR Prior Utilization Review Statistics
- Q2 2020 AR Prior Utilization Review Statistics
- Q1 2020 AR Prior Utilization Review Statistics
- Q4 2019 AR Prior Utilization Review Statistics
- Q3 2019 AR Prior Utilization Review Statistics
- Q2 2019 AR Prior Utilization Review Statistics
- Q1 2019 AR Prior Utilization Review Statistics
- Q4 2018 AR Prior Utilization Review Statistics
- Q3 2018 AR Prior Utilization Review Statistics
- Q2 2018 AR Prior Utilization Review Statistics
- Q1 2018 AR Prior Utilization Review Statistics
Yes. Many DHMO and DC plans have a specialty referral process. The process may differ depending on the plan. Please contact our Provider Services team at 800-822-5353 for more information.
You can upload supporting documents online to DentalXChange, Tesia and FastAttach from NEA, powered by Vyne.
Yes. You can enroll your organization for direct deposit of claim payments. To learn about electronic payment solutions, review our Electronic Payment Enrollment information. To enroll in free ACH, visit UHCdental.epayment.center/register or call 855-774-4392. For other electronic payment options, such as Virtual Credit Card or ACH+, contact Zelis at 877-828-8770.
The Fee Schedule page on UHCdental.com shows the current fee schedule in real time. The Treatment Plan Cost Calculator shows the pricing of the claim as of the member’s date of service.
No. You are unable to view inactive fee schedules.
Yes. We follow this process for COB claims:
- Potential claims situations are identified when:
- Other insurance is indicated on the claim form or at the time of enrollment
- Spouse employment is indicated on the claim form or at the time of enrollment
- After the potential situation has been identified, processors are automatically alerted each time a claim is received and processed
- The system contains online edits for prior experience by the claimant
- The processor determines if UnitedHealthcare is the primary or secondary carrier
- If UnitedHealthcare is the primary carrier, we pay the claim and the member submits the claim to the secondary carrier with a copy of the explanation of benefits showing the primary payment
- If UnitedHealthcare is the secondary carrier, the member is notified, and we adjudicate the claim after the primary carrier has made their payment. In this scenario, the savings are calculated as the difference between the amount paid as the secondary carrier and the amount that would have been paid as the primary carrier.
- Recovery for COB is done in-house. The identification of other coverage is maintained indefinitely until a change is noted on a subsequent claim and is associated with subscriber (and all members of the family)
Claims are subject to COB when we are notified that other insurance exists. If we are the secondary insurance carrier, previously paid amounts are applied against the allowable amount.
Yes. We apply the birthday rule when administering COB. If both parties have the same birthday, we determine which plan has covered the patients longer.
The savings from COB claims are maintained within the claims system and can be accumulated both on a year-to-date and calendar-year basis.
Yes. You can submit them through the member’s medical plan as an out-of-network provider. Download the COVID-19 Vaccine Claim Submission Information PDF for details.
Yes. The Centers for Medicare & Medicaid Services (CMS) mandates health care providers maintain accurate online directories. To help meet this requirement, you must review your directory every 90 days and notify us of changes, including:
- Address updates
- Tax ID information
- Dentist leaving or joining practice
- Status of accepting or not accepting new patients
To make updates to your profile, go to UHCdental.com, sign in and select Provider Self Service under Quick Links, or use the Provider Information Demographic Change Submission Form.
Yes. You must fulfill a 1-year commitment on your contract before requesting changes.
You must provide written notice 90 days prior to terminating your contract. Once the notification has been received, a network contractor will reach out to you to discuss the next steps. Submit termination letters by:
- Email to firstname.lastname@example.org
- Fax to 248-733-6372
- Mail to:
PO Box 30567
Salt Lake City, UT 84130
- Phone to Customer Service at 800-822-5353
You may not balance bill the member if the services rendered are covered on the member’s plan. There may be instances when the services are not covered. For example, a member may have reached the annual and/or frequency limit. In these instances, the member is responsible for your full fee if the services are not covered in the plan — provided this information has been disclosed to the patient prior to services being rendered.
You need to complete the application process to participate in our network.
- Go to UHCdental.com
- Select "Join Our Network" on the top navigational bar and request a provider packet
- Complete and submit the required paperwork
Once your paperwork is received, a network contractor will contact you to discuss how the plan is reimbursed and the next steps in the process.
No. There is no charge or membership fee to join the network.
Once you submit the documents, your local network contractor will reach out to you to discuss the documents received and the contracted rates for plans in your area. Your network contractor will send a contract for the owner of the tax identification number to sign and complete the application process.
We cannot move forward with the credentialing process if the contract is not returned, or the application is incomplete. Please promptly return the information to avoid a delay activating the dentist in our network.
Our credentialing process takes approximately 90 days to complete.
No. You have the option but are not required to join all available networks in your area.
Yes. We’re a participating organization that uses the American Dental Association® credentialing service, powered by CAQH ProView®. Get more information on how to simplify your credentialing process.