Mar 01, 2023
UnitedHealthcare requires employers to meet participation and eligibility requirements throughout the entire policy period. To ensure this requirement is being met, UnitedHealthcare may request that their employer groups provide information verifying compliance with these guidelines.
If an audit is required, UnitedHealthcare will send notice to both the employer group and broker. Only one follow up letter will be sent. Any request for information must be received in its entirety by the date listed in the employer’s letter. If a group does not respond they can be terminated, even if they’re in compliance with participation and eligibility requirements.
How You Can Help
If you receive an audit notice, reach out to your client to make sure they know they must comply with the request to continue their coverage.
Using your clients group number, you can check the status of your client’s audit in the Employer Group Eligibility Verification tool.1
If a client shows a status of Incomplete, they have either not responded or need to provide additional information to prove their eligibility.
Refer to the How to Complete an Eligibility Verification Audit on uhceservices.com job aid, which provides details, including annotated screen images to help producers and clients become familiar with the new, online audit response features
Questions about your Eligibility Audit?
Please contact Risk Management at: risk.management@uhc.com
1 Once the client submits their information, please allow up to 5 business days for UnitedHealthcare to process information and update status.
