Granite City Claims Reimbursement Project
To ensure a timely turnaround of your reimbursement claims to streamline the process, we are providing you with revised guidelines for the claims submission procedure.
For Pharmacy Claims:
- Provide the actual prescription receipt showing patient name, date, drug name, quantity, amount paid by employee, and amount paid by insurance (or amount insurance saved you);
OR
- Provide the prescription profile listing from the pharmacy containing patient name, quantity, date, drug name, amount paid by employee, and amount paid by the insurance (or amount insurance saved you);
OR
- Provide the printout from UHC containing patient name, quantity, date, drug name, amount paid by employee, and amount paid by insurance (or amount insurance saved you). The listing from UHC is the preferred source of documentation of these three options for prescription claims filed for reimbursement
Frequently asked questions
Why do we need to provide the name of the drug?
In order to determine the tier the drug belongs to, we need to know the name of the drug.
Why do we need to know the amount insurance saved?
This is an indication that prescription was processed by UHC. We cannot reimburse amounts for drugs rejected by UHC, and we cannot reimburse prescriptions that were never processed by UHC. These will be rejected as ineligible.
For office visit co-pays:
In-Network
- Provide a billing statement from the doctor showing the services provided and the associated cost;
OR
- Provide an EOB summary from UHC. The UHC summary is the preferred source of documentation of these two options.
Out of Network
- Provide a detailed EOB from UHC.
Hospital, Chiropractor, ambulance, Mental Health, and any other Ancillary Services
- Provide a detailed EOB from UHC.
Other helpful hints:
- Separate and group each family member.
- Use one form for pharmacy claims and a separate form for medical claims.
- The amount paid is the amount you paid, not the toal amount of the claim. For example, a hospital visit may be $1,500.00, but you would pay the $100.00 deductible plus 10% of the cost, about $1400.00.
- You can provide EOBs, EOB summaries, or pharmacy listings by printing them out through myuhc.com. For those who do not have access to a computer, you can call or write to UHC to request this information and have it sent to you.
Claims that do not have the appropriate supporting documentation, at the time of submission, cannot be processed and will be rejected. It is your responsibility to provide documentation.
Your help and cooperation are essential to the process of reviewing claims for timely reimbursement. Thank you.
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