Effective Dec. 1: Mandatory Electronic Submission for Arizona Medicaid Appeals and Disputes

Starting Dec. 1, 2024, you’ll be required to submit medical pre- and post-service appeals and disputes electronically. This change affects most* network healthcare professionals (primary and ancillary) and facilities that provide services to UnitedHealthcare Community Plan (Medicaid) members in Arizona.

If you use an outside vendor, such as a revenue cycle management company, please ensure they’re aware of the following changes and digital workflow options.

How To Submit A Pre-Service Appeal

Use the Prior Authorization and Notification tool through the UnitedHealthcare Provider Portal:

• To access the Prior Authorization and Notification tool on the UnitedHealthcare Provider Portal:
• Visit UHCprovider.com and click "Sign In"
• Log in with your One Healthcare ID
• New users: Create an account at UHCprovider.com/access
• Select "Prior Authorizations" from the menu
• Under "View Status of existing submissions, drafts and make updates," click "Search Existing Submissions & Drafts"
• Locate your service reference number (SRN) and expand for details
• If the status is "Not Covered/Not Approved," look for "File a Pre-Service Appeal or a Grievance" link
• Alternatively, click the SRN to view the original case details and find the appeal/grievance link
• Clicking the link opens a new tab with submission form instructions
• Follow the guided process to submit your appeal, including document uploads
• To find pre-service appeal or dispute letters, use Advanced Filter in the Document Library

How To Submit Post-Service Appeals And Disputes

Here are two ways to access UnitedHealthcare's services:

Option 1: UnitedHealthcare Provider Portal

• Go to any page on UHCprovider.com and click "Sign In."
• Log in using your One Healthcare ID.
• If you don’t have a One Healthcare ID, visit UHCprovider.com/access to create one.
• Once logged in, navigate to the menu and select "Claims & Payments." Then, choose "Look up a Claim" to search by claim number and take further action.

Option 2: Application Programming Interface (API)

• The API offers a fully electronic solution that automates administrative tasks. This option is ideal for organizations with medium-to-high claim volumes that have the technical capabilities to program an API or can outsource the implementation.

For more details, visit the UnitedHealthcare Provider Portal.